NUR 211 Wk 8 - Management of Patients with Oncologic or Degenerative Neurologic Disorders

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In which location are most brain angiomas located?

Cerebellum pg. 2053

A client with a spinal cord injury says he has difficulty recognizing the symptoms of urinary tract infection (UTI). Which symptom is an early sign of UTI in a client with a spinal cord injury? A. Frequency of urination B. Burning sensation on urination C. Lower back pain D. Fever and change in urine clarity

Nursing students are reviewing the various types of brain tumors. The students demonstrate understanding of the material when they identify which of the following as the most common type?

Gliomas

A client with amyotrophic lateral sclerosis (ALS) is being visited by the home health nurse who is creating a care plan. Which of the following nursing diagnoses is most likely for a client with this condition? Chronic confusion Impaired urinary elimination Impaired verbal communication Bowel incontinence

Impaired verbal communication

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

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 pg. 2076

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?

Low bone mass and osteoporosis

Which of the following is a late symptom of spinal cord compression?

Paralysis pg. 2056

Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells?

Parkinson disease

A health care provider needs help in identifying the precise location of a brain tumor. To measure brain activity, as well as to determine structure, the nurse expects the health care provider to order which of the following tests?

Positron-emission tomography (PET)

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

Severe lower back pain

Which of the following provides the best outcome for most tumor types?

Surgery

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.

Which patient will the nurse assess for degenerative neurologic symptoms?

The patient with Huntington disease

What interventions will best help the client with Huntington disease relieve anxiety and increase communication? Select all that apply.

Use biofeedback. Consult with a speech therapist.

neurodegenerative

a disease, process, or condition leading to deterioration of cells or function of the nervous system

papilledema

edema of the optic nerve usually due to increased intracranial pressure (ICP)

dyskinesia

impaired ability to execute voluntary movements

chorea

rapid, jerky, involuntary, purposeless movements of the extremities or facial muscles, including facial grimacing

dysphonia

voice impairment or altered voice production

"Driving a car should be avoided until the you know how this medication effects you."

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?

"If one parent has the disorder, there is a 50% chance that you will inherit the disease." pg. 2069

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

"Lately he seems to move far more slowly than he ever has in the past."

Nursing Management of MS

- minimize spasticity and contractures - regulation of activity and rest - prevent injury

The nurse is providing discharge teaching to a client with a spinal cord tumor and instructs the client to avoid hot water bottles and heating blankets for what reason? 1- Impaired sensory perception 2- Motor weakness 3- Medication side effects 4- Cognitive impairment

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

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

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 132 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

600

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

750

Medical Management of MS

- corticosteroids (anti-inflammatory agents) - non-steroidal immunosuppressives - interferons - baclofen (spasticity - symmetrel (fatigue)

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

The nurse educator is providing orientation to a new group of staff nurses on an oncology unit. Part of the orientation is to help nurses understand the differences between various types of brain tumors. The nurse educator correctly identifies that glioma tumors are classified based on the fact that they originate where in the brain? 1- Within the brain tissue 2- From the coverings of the brain 3- In the cranial nerves 4- From metastasis of a primary tumor

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

An older adult patient exhibiting clinical manifestations of a brain tumor is admitted to the hospital for testing. What tumor types does the nurse know are commonly seen in the older adult? A. anaplastic astrocytoma B. cerebral metastasis from other sites C. glioblastoma multiforme D. medulloblastoma

The nurse teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder?

Autosomal dominant

The nurse is caring for a client with an inoperable brain tumor. What is a major threat to this client? A Hypovolemia B Increased intracranial pressure C Decreased intracranial pressure D Hypervolemia

Which anticholinergic agent is used to control tremor and rigidity in Parkinson disease? Bromocriptine mesylate Benztropine Mesylate Amantadine Levodopa

Benztropine Mesylate

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

Care of the cervical collar

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 participates in daily hygiene activities with assitive devices.

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? Glutamate Acetylcholine Dopamine Serotonin

Dopamine

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter?

Dopamine pg. 2063

An acoustic neuroma is a benign tumor of which cranial nerve?

Eighth

An acoustic neuroma is a benign tumor of which cranial nerve?

Eighth pg. 2053

Encourage the client to massage the facial and neck muscles before eating.

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

Glutamate

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

Hearing loss usually occurs. An acoustic neuroma is a benign tumor of the eighth cranial nerve. About 50% can be treated with surgery. Hearing loss always occurs. Compression on the fifth cranial nerve can also cause facial paresthesia.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?

Ineffective airway clearance

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

Magnetic resonance imaging (MRI) pg. 2056

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client?

Magnetic resonance imaging pg. 2056

Which of the following is a late symptom of spinal cord compression?

Paralysis

The nurse is caring for a patient with Huntington disease. What intervention is a priority for safe care?

Protecting the patient from falls

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action? Keeping a pillow under the client's knees at all times Placing the client in semi-Fowler's position Maintaining bed rest for 72 hours after the laminectomy Turning the client from side to side, using the logroll technique

Turning the client from side to side, using the logroll technique

Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy?

Client participates in activities of daily living using adaptive devices. pg. 2072

To assess a client's cranial nerve function, a nurse should assess: A. orientation to person, time, and place. B. hand grip. C. arm drifting. D. gag reflex.

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? Acetylcholine Dopamine Serotonin Phenylalanine

Dopamine

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?

Explaining hospice care and services

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

Glutamate

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:

Growth is slow and symptoms are caused by compression rather than tissue invasion pg. 2053

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 -Removal of all or part of the tumor -Elimination of distressing signs and symptoms -Reduced incidence of recurrence

Improved quality of life 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.

During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority? Give the client something to help induce sleep. Change the client's bandages. Notify the client's surgeon. Increase the client's pain medication.

Notify the client's surgeon.

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 pg. 2073-2074.

The nurse caring for a client diagnosed with Parkinson disease has prepared a plan of care that would include what goal? Promoting effective communication Controlling diarrhea Preventing cognitive decline Managing choreiform movements

Promoting effective communication

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?

Respiratory dysfunction

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be?

The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication. pg. 2064

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

Turning the client from side to side, using the logroll technique

dementia

broad term for a syndrome characterized by a general decline in higher brain functioning, such as reasoning, with a pattern of eventual decline in ability to perform even basic activities of daily living, such as toileting and eating

spondylosis

degenerative changes occurring in a disc and adjacent vertebral bodies; can occur in the cervical or lumbar vertebrae

A nurse is working on a surgical floor. The nurse must logroll a client following a:

laminectomy

A nurse is working on a surgical floor. The nurse must logroll a client following a:

laminectomy.

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

laminectomy.

A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by:

performing capillary glucose testing every 4 hours. pg. 1880

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 may experience progressive deterioration in all voluntary muscles."

Other Manifestations of Parkinson's Disease

- diaphoresis - orthostatic hypotension - gastric/urinary retention - constipation - sleep disorders - depression

Seizure Disorders

- episodes of abnormal motor, sensory, autonomic, psychic activity resulting from sudden excessive damage from cerebral neurons - part or all of brain may be involved - sudden and transient

Clinical Manifestations of MS

- fatigue - weakness - numbness - coordination difficulties (ataxia) - loss of balance - visual disturbances - spasticity of extremities - loss of abdominal reflexes - paresthesia - pain - mild cognitive impairment - depression - tremor

A client diagnosed with a malignant brain tumor is scheduled to receive chemotherapy intrathecally. When explaining this technique to the client, the nurse would describe the medication as being injected into which area? 1- Subarachnoid space 2- Central vein 3- Implanted port 4- Epidural space

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

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client? 1- Surgery 2- Radiation therapy 3- Chemotherapy 4- Immunotherapy

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

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

A client with meningitis has a history of seizures. Which should the nurse do to safely manage the client during a seizure? Select all that apply. A. Turn the client to the side. B. Provide verbal reassurance. C. Inspect the oral cavity and teeth. D. Physically restrain the client's movements.

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

ABCD

The causes of acquired seizures include what? (Mark all that apply.) A. Brain tumor B. Drug and alcohol withdrawal C. Cerebrovascular disease D. Metabolic and toxic conditions E. Hypernatremia

ABCD

Which of the following symptoms are indicative of a rapidly expanding acute subdural hematoma? Select all that apply. A. Decreased reactivity of the pupils B. Bradycardia C. Tachypnea D. Hemiparesis E. Hypotension F. Coma

ABDF

Which of the following is a disease in which there is a loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?

Amyotrophic lateral sclerosis (ALS)

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

1,2,3,4

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? 1- How to exercise 2- How to perform household tasks 3- How to take a bath 4- How to facilitate tasks such as using both hands to hold a drinking glass

A nurse is caring for a client who has returned to his room after a carotid endarterectomy. Which action should the nurse take first? A. Ask the client if he has trouble breathing. B. Place antiembolism stockings on the client. C. Take the client's blood pressure. D. Ask the client if he has a headache.

The nurse is planning discharge education for a client with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. What would the nurse be correct in teaching the client to avoid? A. Washing his face B. Exposing his skin to sunlight C. Drinking large amounts of fluids D. Using artificial tears

A male client is having a tonic-clonic seizures. What should the nurse do first? a. Elevate the head of the bed. b. Restrain the client's arms and legs. c. Place a tongue blade in the client's mouth. d. Take measures to prevent injury.

Answer D. Protecting the client from injury is the immediate priority during a seizure. Elevating the head of the bed would have no effect on the client's condition or safety. Restraining the client's arms and legs could cause injury. Placing a tongue blade or other object in the client's mouth could damage the teeth

A male client with a spinal cord injury is prone to experiencing automatic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence? a. Strict adherence to a bowel retraining program b. Keeping the linen wrinkle-free under the client c. Preventing unnecessary pressure on the lower limbs d. Limiting bladder catheterization to once every 12 hours

Answer D. The most frequent cause of autonomic dysreflexia is a distended bladder. Straight catheterization should be done every 4 to 6 hours, and foley catheters should be checked frequently to prevent kinks in the tubing. Constipation and fecal impaction are other causes, so maintaining bowel regularity is important. Other causes include stimulation of the skin from tactile, thermal, or painful stimuli. The nurse administers care to minimize risk in these areas.

The nurse educator is teaching nursing students about various types of brain tumors. The instructor recognizes that teaching has been effective when students correctly identify a client whose lab work indicates excessively high levels of thyroid stimulating hormone would most likely be diagnosed with which type of tumor? A Angioma B Neuroma C Glioblastoma D Pituitary adenoma

During the Tensilon test to determine if the patient has myasthenia gravia, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42 and respiration 18. What intervention should the nurse prepare to do? A. place the patient in the supine position B. administer diphenhyramine (Benadryl) for the allergic reaction C. administer atropine to control the side effects of the edrophonium D. call the rapid response team because the patient is preparing to arrest

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

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? -Offering family support groups -Optimizing nutrition -Explaining hospice care and services -Managing muscle weakness

Explaining hospice care and services 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.

A client is admitted to the hospital with pneumonia. He has a history of Parkinson disease, which his family says is worsening. Which assessment should the nurse expect? Impaired speech Muscle flaccidity Pleasant and smiling demeanor Tremors in the fingers that increase with purposeful movement

Impaired speech

The nurse is providing discharge teaching for a client who was admitted to hospital after having complex partial seizures secondary to a glioma. The client has been prescribed levetiracetam to manage the seizures. What should the nurse include in the discharge teaching for this medication? 1- "If a corticosteroid has been prescribed, do not take it at the same time as this medication." 2- "If the previous day's dose was forgotten, take two at the regular time the next day." 3- "Suicidal ideation is a common side effect of this medication and should be reported immediately." 4- "Driving a car should be avoided until the you know how this medication effects you."

A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following?

Balance and coordination

A client has a spinal cord injury. The home health nurse is making an initial visit to the client at home and plans on reinforcing teaching on autonomic dysreflexia. What symptom would the nurse stress to the client and his family? (Ch. 45 pg. 1309) A. Rapid heart rate B. Runny nose C. Sweating D. Slight headache

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

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

The nurse is developing a plan of care for a client with Guillain-Barré syndrome. Which of the following interventions should the nurse prioritize for this client? A. Assessing frequently for loss of cognitive function B. Maintaining the client on bed rest C. Providing aids to compensate for loss of vision D. Using the incentive spirometer as prescribed

Which of the following is the only known risk factor for brain tumors?

Ionizing radiation

Which of the following statements reflect nursing interventions of a patient with post-polio syndrome?

Providing care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the patient

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

"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."

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?"

Nursing Management During a Seizure

- circumstances prior to seizure - where the movements or stiffness start - types of movements - areas of the body involved - presence/ absence of automatisms (repetitive movements) - incontinence - duration - loss of consciousness - inability to speak after seizure - does patient sleep afterwards - cognitive status

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors? 1- They can affect vital functioning. 2- They do not require surgical removal. 3- The prognosis is very poor. 4- They are all metastatic.

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

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? A Related to difficulty swallowing B Related to impaired balance C Related to visual field deficits D Related to psychomotor seizures

A client with a head injury is being monitored for increased intracranial pressure (ICP). His blood pressure is 90/60 mm Hg and the ICP is 18 mm Hg; therefore his cerebral perfusion pressure (CPP) is: A. 88 mm Hg. B. 52 mm Hg. C. 68 mm Hg. D. 48 mm Hg.

The nurse is caring for a comatose client. The nurse knows she should assess the client's motor response. Which method may the nurse use to assess the motor response? A. Observing the client's response to painful stimulus B. Assessing the client's sensitivity to temperature, touch, and pain C. Observing the reaction of pupils to light D. Using the Romberg test

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

A patient is admitted complaining of low back pain. What will best assist the nurse in determining if the pain is related to a herniated lumbar disc?

Have the patient lie on his back and lift his leg, keeping it straight.

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

Related to impaired balance pg. 2055

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

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

Bone density testing in patients with post-polio syndrome has demonstrated.

low bone mass and osteoporosis.

27. A patient has been admitted to the Neuro ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. What is an important part of the initial assessment on this patient? A) The gag reflex B) Ability to chew C) Sensory perception D) Corneal reflex

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 1980, Primary Brain Tumors Feedback: Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes teaching the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. The ability to chew and the corneal reflex would be assessed and so would sensory perception on the face, but none of them are more important than the gag reflex.

The nurse is planning the care of a patient with a TBI in the neurosurgical ICU. In developing the plan of care, what interventions should be a priority? Select all that apply. A. Setting priorities for nursing interventions B. Initiating rehabilitation C. Making nursing assessments D. Anticipating needs and complications E. Ensuring that the patient regains full brain function

ABCD

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. A. Tremor B. Bradykinesia C. Intellectual decline D. Postural instability E. Rigidity

ABDE

The statements presented here match nursing interventions with nursing diagnoses. Which statements are true for a client with a stroke? Select all that apply. A. Impaired verbal communication: Repeat words and instructions. B. Impaired swallowing: Provide a pureed diet. C. Self-care deficit: Instruct the client on use of a walker. D. Impaired physical mobility: Provide wide-grip utensils during meals. E. Disturbed sensory perception: Stand on the client's unaffected side.

ABE

The nurse plays a critical role in the initial work-up of a patient with acute stroke symptoms. An immediate decision is to determine if the stroke is ischemic or hemorrhagic. Although there is overlap in some motor, sensory, and cognitive changes, hemorrhagic strokes can be identified by some specific signs. Which of the following signs are consistent with a hemorrhagic stroke? Select all that apply. A. Seizures B. Sudden, severe headache C. Loss of balance D. Altered level of consciousness E. Numbness or weakness of an extremity F. Vomiting

ABF

Methods of pain control after surgery Adjusting to changes in daily activities Question about current bowel and bladder control

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

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

Spinal metastasis pg. 2062

Subarachnoid space

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

laminectomy. 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.

A female client has clear fluid leaking from the nose following a basilar skull fracture. The nurse assesses that this is cerebrospinal fluid if the fluid: a. Is clear and tests negative for glucose b. Is grossly bloody in appearance and has a pH of 6 c. Clumps together on the dressing and has a pH of 7 d. Separates into concentric rings and test positive of glucose

Answer D. Leakage of cerebrospinal fluid (CSF) from the ears or nose may accompany basilar skull fracture. CSF can be distinguished from other body fluids because the drainage will separate into bloody and yellow concentric rings on dressing material, called a halo sign. The fluid also tests positive for glucose.

A nurse working in the neurologic intensive care unit admits from the emergency department a patient with an inoperable brain tumor. Of the two choices of posturing exhibited in the above image, which one demonstrates a deeper and more severe dysfunction? A. A (Armscrossed) B. B (Arms straight) C. both demonstrate severe dysfunction D. neither is considered severe

A patient is having a lumbar puncture and the physician has removed 20 mL of cerebrospinal fluid. What nursing intervention is a priority after the procedure? A. Have the patient lie flat for 1 hour and then sit for 1 hour before ambulating. B. Have the patient lie flat for 6 hours. C. Early ambulation D. Have the patient lie in a semi-Fowler's position with the head of the bed at 30º.

A client has been admitted to the ICU after being recently diagnosed with an aneurysm and the client's admission orders include specific aneurysm precautions. What nursing action will the nurse incorporate into the client's plan of care? A. Elevate the head of the bed to 75 degrees. B. Leg exercises to prevent deep vein thrombosis C. Maintain the client on complete bed rest. D. Administer enemas when the client is constipated.

A client has recently begun mobilizing during the recovery from an ischemic stroke. To protect the client's safety during mobilization, the nurse should perform what action? A. Support the client's full body weight with a waist belt during ambulation. B. Avoid mobilizing the client in the early morning or late evening. C. Have a colleague follow the client closely with a wheelchair. D. Ensure that the client's family members do not participate in mobilization.

A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intraveneously. The nurse is careful to assess which of the following related to intake of nutrients? A. Urinary output and capillary refill B. Respiratory status C. Gag reflex and bowel sounds D. Condition of skin

The nurse is caring for a client who has sustained a spinal cord injury (SCI) at C5 and has developed a paralytic ileus. The nurse will prepare the client for which of the following procedures? (Ch. 45 pg. 1308) A. Bowel surgery B. A large volume enema C. Insertion of a nasogastric tube D. Digital stimulation

The nurse is caring for a patient who was involved in a motor vehicle accident and sustained a head injury. When assessing deep tendon reflexes (DTR), the nurse observes diminished or hypoactive reflexes. How will the nurse document this finding? A. 0 B. 3+ C. 1+ D. 2+

A 69-year-old client is brought to the ED by ambulance because a family member found him lying on the floor disoriented and lethargic. The health care provider suspects bacterial meningitis and admits the client to the ICU. What interventions should the nurse perform? Select all that apply. (Ch.46 pg. 1323) A. Place the client in positive pressure isolation B. Obtain a blood type and cross-match C. Perform frequent neurologic assessments D. Administer antipyretics as prescribed E. Monitor pain levels and administer analgesics

CDE

Which interventions are appropriate for a client with increased intracranial pressure (ICP)? Select all that apply. A. Elevating the head of the bed to 90 degrees B. Encouraging deep breathing and coughing every 2 hours C. Maintaining aseptic technique with an intraventricular catheter D. Administering prescribed antipyretics E. Frequent oral care

CDE

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

Call the surgeon to report the client's pain.

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? A "He has pneumonia; I shouldn't have let him go to that party last week." B "Yes, he has an advance directive." C "This is the third time he's had pneumonia in the past 6 months. I'm afraid he needs a feeding tube." D "He is only 17. He doesn't need an advance directive."

A client with a cervical disc herniation in the acute phase reports of numbness and tingling in the arms. What are the priority interventions for the nurse to perform? Select all that apply. Have the client wear a cervical collar daily Assist the client in isometric exercises of the arms Provide NSAID therapy Encourage weight lifting to strengthen arms Encourage exercises to strengthen the legs

Have the client wear a cervical collar daily Provide NSAID therapy

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

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

A patient has recently been diagnosed with an acoustic neuroma. The nurse helps the patient understand that:

Hearing loss usually occurs.

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

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client?

Magnetic resonance imaging

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client? -Magnetic resonance imaging -Ultrasonography -Computed tomography -Core needle biopsy

Magnetic resonance imaging Magnetic resonance imaging is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.

A client who has a pituitary adenoma would report which symptoms related to the presence of this type of tumor? Select all that apply.

Morning headaches Chiasmal syndrome Polydipsia Anorexia

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

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

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

Protecting the client from falls The client with Huntington disease has a risk for injury from falls and skin breakdown. Protecting the client from falls is a priority for safe care. Electrolyte and cholesterol monitoring is not a priority for this condition. Range-of-motion exercises will not protect the client from injuries.

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

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

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

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

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? -"Any tissue that was dead will be removed." -"My headache and nausea should be lessened somwhat." -"The surgeon will be able to remove all of the tumor." -"There will be less cancer left that might be resistant to chemotherapy."

"The surgeon will be able to remove all of the tumor." For clients with malignant gliomas, complete removal of the tumor and cure are not possible but the rationale for resection includes relief of increased intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theorectically leaves behind fewer cells to become resistant to radiation or chemotherapy.

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? "Treatment aims at keeping you independent as long as possible." "Treatment really doesn't matter; the disease is going to progress anyway." "Treatment for Parkinson's is only palliative; it keeps you comfortable." "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease."

"Treatment aims at keeping you independent as long as possible."

Current Alzheimer's Disease Theories

- brain changes - neurotransmitters - beta amyloid and amyloid precursor protein - genetic factors - environmental factors - viral origin

Nursing Management of Parkinson's Disease

- improve mobility - enhance self care activities - improve bowel elimination - improve nutrition - improve communication - support coping abilities

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

The nurse explains to the client with projectile vomiting and severe headache that a medication is being prescribed to reduced edema surrounding the brain and lessen these symptoms. What medication is the nurse preparing to administer? 1- Mannitol 2- Temozolomide 3- Bevacizumab 4- Everolimus

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

A nurse knows that a patient exhibiting seizure-like movements localized to one side of the body most likely has what type of tumor?

A motor cortex tumor

A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approve for the treatment of this symptom? A. tetrabenazine (xenazine) B. carbamazepine (Tegretol) C. phenobarbital D. diazepam (valium)

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

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

A client is admitted for evaluation of cerebral aneurysm. Which assessment finding is of greatest importance in prioritizing nursing care to this client? A. Complaint of headache off and on for past month B. Frequent voiding C. Nausea D. No bowel movement since yesterday

Which of the following diagnostic studies provides visualization of cerebral blood vessels? A Cytologic studies of cerebrospinal fluid (CSF) B Positron emission tomography (PET) C Cerebral angiography D Computer-assisted stereotactic biopsy

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

Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

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.

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

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy?

Muscle biopsy

A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma:

Originated within the brain tissue.

Which of the following diseases 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?

Parkinson's disease

A client comes to the clinic reporting low back pain and muscle spasms. He states, "The pain seems to travel into my hip and down to my leg." A herniated lumbar disk is suspected. Which of the following would help to confirm the suspicion? Select all that apply. Postural deformity Muscle weakness Negative straight leg test Altered tendon reflexes Increased pain with bed rest

Postural deformity Muscle weakness Altered tendon reflexes

A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? Anxiety Powerlessness Ineffective denial Risk for disuse syndrome

Powerlessness

Which of the following statements indicate appropriate nursing intervention for a patient with postpolio syndrome?

Providing care aimed at slowing the loss of strength and maintaining overall well-being.

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

Respiratory dysfunction

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

Risk for injury

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

Semisolid food with thick liquids

The nurse is caring for a patient admitted to the hospital with a brain abscess that developed from an untreated case of otitis media. What assessment data is a priority to alert the nurse to changes in intracranial pressure? A. level of consciousness B. peripheral pulses C. sensory perception D. crackles bilaterally

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

When the client is resting

Bone density testing in patients with post-polio syndrome has demonstrated

low bone mass and osteoporosis.

paresthesia

numbness, tingling, or a "pins and needles" sensation

sciatica

pain and tenderness that radiates along the sciatic nerve that runs through the thigh and leg

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

After a stroke, a client is admitted to the facility. The client has left-sided weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which nursing intervention is a priority for this client? A. Elevating the head of the bed to 30 degrees B. Performing range-of-motion (ROM) exercises on the left side C. Checking stools for occult blood D. Keeping skin clean and dry

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? A. within 24 hours after exposure B. within 48 hours after exposure C. within 72 hours after exposure D. therapy is not necessary prophylactically and should only be used if the person develops symptoms

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

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

2. A 25-year-old female with brain metastases asks the nurse about the length of time she has to live. Based upon the fact that the patient is not receiving treatment for the brain metastases, the nurse's best response is that patients with this condition generally have a mean survival time of what? A) 2 weeks B) 1 month C) 6 months D) 1 year

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1981, Cerebral Metastases Feedback: The median survival time for patients with no treatment for brain metastases is 1 month; with corticosteroid treatment alone it is 2 months; radiation therapy extends the median survival to 3 to 6 months. Therefore, options A, C, and D are incorrect.

The nurse is positioning the female client with increased intracranial pressure. Which of the following positions would the nurse avoid? a. Head mildline b. Head turned to the side c. Neck in neutral position d. Head of bed elevated 30 to 45 degrees

Answer B. The head of the client with increased intracranial pressure should be positioned so the head is in a neutral midline position. The nurse should avoid flexing or extending the client's neck or turning the head side to side. The head of the bed should be raised to 30 to 45 degrees. Use of proper positions promotes venous drainage from the cranium to keep intracranial pressure down.

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

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: a. Getting too little exercise b. Taking excess medication c. Omitting doses of medication d. Increasing intake of fatty foods

Answer C. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.

A male client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client to ensure client safety? a. Speak loudly to the client b. Test the temperature of the shower water c. Check the temperature of the food on the delivery tray. d. Provide a clear path for ambulation without obstacles

Answer D. Cranial nerve II is the optic nerve, which governs vision. The nurse can provide safety for the visually impaired client by clearing the path of obstacles when ambulating. Testing the shower water temperature would be useful if there were an impairment of peripheral nerves. Speaking loudly may help overcome a deficit of cranial nerve VIII (vestibulocochlear). Cranial nerve VII (facial) and IX (glossopharyngeal) control taste from the anterior two thirds and posterior third of the tongue, respectively.

A client with a C5 spinal cord injury has tetraplegia. After being moved out of the ICU, the client reports a severe throbbing headache. What should the nurse do first? A. Reassure the client that headaches are expected during recovery from spinal cord injuries. B. Check the client's indwelling urinary catheter for kinks to ensure patency. C. Lower the HOB to improve perfusion. D. Administer PRN analgesia as prescribed.

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

The nurse is caring for a client immediately after a spinal cord injury. Which assessment finding is essential when caring for a client in spinal shock with injury in the lower thoracic region? A. Numbness and tingling B. Pulse and blood pressure C. Respiratory pattern D. Pain level

The nurse is performing stroke risk screenings at a hospital open house. Identification of high-risk individuals is the goal of the screenings. The nurse has identified four patients who might be at risk for a stroke. Which patient is likely at highest risk for a stroke? A. Black man, age 50 with history of smoking B. White man, age 60 with history of uncontrolled hypertension C. Black man, age 60, with history of diabetes D. White woman, age 60 with history of excessive alcohol intake

When caring for a client with a head injury, a nurse must stay alert for signs and symptoms of increased intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP? A. Hypertension and narrowing pulse pressure B. Rising blood pressure and bradycardia C. Hypotension and bradycardia D. Hypotension and tachycardia

In which specific instances should the nurse assess the client's cranial nerves? Select all that apply. A. When a neurogenic bladder develops B. In the presence of peripheral nervous system disease C. When a spinal reflex is interrupted D. With brain stem pathology E. When level of consciousness is decreased

BDE

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? (Ch. 46 pg. 1318) A. Padded tongue blade B. Nasal cannula and oxygen C. Sphygmomanometer D. Suction machine with catheters

A nurse is performing a neurologic assessment on a client. The nurse observes the client's tongue for symmetry, tremors, and strength, and assesses the client's speech. Which cranial nerve is the nurse assessing? A. IX B. VI C. IV D. XII

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc?

Have the client lie on the back and lift the leg, keeping it straight.

The nurse is volunteering for a Red Cross blood drive and is taking the history or potential donors. Which volunteer would the nurse know will not be allowed to donate blood? A. a donor with a history of hypertension with a blood pressure of 140/90 mm Hg B. a donor who is taking medication for benign prostatic hyperplasia C. a donor who moved to the United States from Canada D. a donor who was in college in England for 1 year

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

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

The nurse is providing education to a group of young people about the dangers of tattoos and body piercings. Which of the following would the nurse describe as a possible result of a tongue piercing?

Brian Abscess

Multiple Sclerosis (MS)

- chronic, degenerative progressive disorder of CNS - characterized by small patches of demyelination in the brain and spinal cord - most common in people living in northern temperate climate zones - most disabling disease of young adults (20-40) - affects women twice as often as men

Clinical Manifestations of ALS

- progressive muscle weakness - muscle atrophy - fasciculations (twitching) - difficulty talking, swallowing, breathing

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

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

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

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

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

There is a high risk for ineffective coping in a client with a recent spinal cord injury. Which nursing interventions will assist the client with this process? Select all that apply. A. Involve the client actively in selfcare. B. Assist the client in accepting the severity of deficits. C. Offer encouragement as the client makes progress. D. Reassure the client by stating, "Everything is going to be all right."

19. A patient with Hungtington's disease has just been admitted to a long-term care facility. The charge nurse is creating a care plan for this patient. Nutritional management for a patient with Huntington's disease often focuses on which of the following characteristics? A) The patient will have an increased appetite. B) The patient will have a decreased appetite. C) The patient will require a clear liquid diet. D) The patient will require a diet limited in protein.

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1993, Huntington Disease Feedback: Due to the continuous involuntary movements, patients will have a ravenous appetite. Despite this ravenous appetite, patients usually become emaciated and exhausted. As the disease progresses, patients experience difficulty in swallowing and thin liquids should be avoided. Protein will not be limited with this disease.

For a male client with suspected increased intracranial pressure (ICP), a most appropriate respiratory goal is to: a. prevent respiratory alkalosis. b. lower arterial pH. c. promote carbon dioxide elimination. d. maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg

Answer C. The goal of treatment is to prevent acidemia by eliminating carbon dioxide. That is because an acid environment in the brain causes cerebral vessels to dilate and therefore increases ICP. Preventing respiratory alkalosis and lowering arterial pH may bring about acidosis, an undesirable condition in this case. It isn't necessary to maintain a PaO2 as high as 80 mm Hg; 60 mm Hg will adequately oxygenate most clients.

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy? A Electromyography B Muscle biopsy C Gram stain of muscle tissue D Family history of muscular dystrophy

Nursing care during the immediate recovery period from an ischemic stroke should include which of the following? A. Administering hypertonic IV solution B. Initiating early mobilization C. Positioning to avoid hypoxia D. Maximizing PaCO2

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? -Glutamate -Dopamine -Serotonin -Acetylcholine

Dopamine The impaired balance and uncontrolled tremors of Parkinson's disease have been linked with low levels of dopamine. The other neurotransmitters have not been implicated in Parkinson's disease in this manner.

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:

Growth is slow and symptoms are caused by compression rather than tissue invasion.

How to facilitate tasks such as using both hands to hold a drinking glass

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

Parkinson disease

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? A. "The disease is not hereditary and therefore there is no risk to you" B. "If one parent has the disorder, there is a 75% chance that you will inherit the disease" C. "If one parent has the disorder, there is a 50% chance that you will inherit the disease." D. "The disease is inherited and all offspring of a parent will develop the disease."

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

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

The nurse is caring for the patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What interventions should be provided in order to determine the presence of autonomic dysfunction. A. assess the respiratory rate and oxygen saturation. B. assess the blood pressure and heart rate C. assess the peripheral pulses D. listen to the bowel sounds

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

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

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.

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? -How to facilitate tasks such as using both hands to hold a drinking glass -How to take a bath -How to exercise -How to perform household tasks

How to facilitate tasks such as using both hands to hold a drinking glass The nurse demonstrates how to facilitate tasks such as using both hands to hold a drinking glass, using a straw to drink, and wearing slip-on shoes. The teaching portion of the care plan would not include how to exercise, perform household tasks, or take a bath.

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

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

A client has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? 1- Hemorrhage 2- Bowel incontinence 3- Respiratory dysfunction 4- Skin breakdown

A client has experienced an ischemic stroke that has damaged the temporal (lateral and superior portions) lobe. Which of the following deficits would the nurse expect during assessment of this client? A. Auditory agnosia B. Lack of deep tendon reflexes C. Hemiplegia or hemiparesis D. Limited attention span and forgetfulness

Nurse Maureen witnesses a neighbor's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to opens the airway in this victim by using which method? a. Flexed position b. Head tilt-chin lift c. Jaw thrust maneuver d. Modified head tilt-chin lift

Answer C. If a neck injury is suspected, the jaw thrust maneuver is used to open the airway. The head tilt-chin lift maneuver produces hyperextension of the neck and could cause complications if a neck injury is present. A flexed position is an inappropriate position for opening the airway.

During assessment of a patient who has been taking dilantin for seizure management for 3 years, the nurse notices one of the side effects that should be reported. What is that side effect? A. Ataxia B. Gingival hyperplasia C. Alopecia D. Diplopia

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following? A. Medication needs to be adjusted to higher doses. B. The client is exhibiting signs of medication overdose. C. The client is having an exacerbation. D. The disease has entered the late stages.

The nurse planning the care of a client with head injuries is addressing the client's nursing diagnosis of "sleep deprivation." What action should the nurse implement? A. Do not disturb the patient between 2200 and 0600. B. Administer a benzodiazepine at bedtime each night. C. Ensure that the client does not sleep during the day. D. Cluster overnight nursing activities to minimize disturbances.

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

Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia?

Huntington disease pg. 2069

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? -Related to visual field deficits -Related to difficulty swallowing -Related to impaired balance -Related to psychomotor seizures

Related to impaired A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

The nurse is caring for a patient with Parkinson's disease and is preparing to administer medication. What does the nurse administer to the patient that is considered most effective drug currently given for the tremor of Parkinson's? A. Requip B. Levodopa C. Symmetrel D. Permax

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? 1- Rapid, jerky, involuntary movements 2- Slow, shuffling gait 3- Dysphagia and dysphonia 4- Dementia

A client has developed diabetes insipidus after having increased ICP following head trauma. What nursing assessment best addresses this complication? (Ch. 45 pg. 1298) A. Serial arterial blood gases (ABGs) B. Vigilant monitoring of fluid balance C. Monitoring of the client's airway for patency D. Continuous BP monitoring

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

A nurse is assessing a client with Parkinson's disease. Which of the following would the nurse expect to find? Gait with the body leaning backward Continuous tremors Muscle flaccidity Slowing of activity

Slowing of activity

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).

Nursing Management After a Seizure

- observe for complications (aspiration, injury) - position side lying - suction - seizure precautions (bed in low position, side rails up/padded)

A, B, C

A college student goes to the infirmary with a fever, headache, and stiff neck. The nurse suspects the student may have meningitis and has the student transferred to the hospital. If the diagnosis is confirmed, what should the nurse institute for those who have been in contact with this student? (Select all that apply.) A. administration of rifampin (Rifadin) B. administration of ciproflaxocin hydrochloride (Cipro) C. administration of ceftriaxone sodium (Rocephin) D. amoxicillin (Amoxil) E. rofecoxib (Vioxx)

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? A. ascending paralysis B. numbness and tingling in the lower extremities C. weakness starting in the muscles supplied by the cranial nerves D. jerky, uncontrolled movements in the extremities

7. A 37-year-old male is brought to the clinic by his wife because the patient is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In preparation for diagnostic studies, the nurse will inform the patient that the most commonly used study to diagnose spinal cord compression from a tumor is what? A) An x-ray B) An ultrasound C) A CT scan D) An MRI scan

Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1984, Spinal Cord Tumors Feedback: The MRI scan is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases. Therefore options A, B, and C are incorrect.

Alzheimer's Disease DSM IV Criteria

- development of multiple cognitive deficits including both memory impairments and one or more of aphasia, apraxia, agnosia, or disturbance in executive functioning - deficits cause significant impairment in social functioning and represent decline from previous function - gradual onset and continued decline - deficits not due to CNS or systemic conditions or substances and do not occur only in delirium

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

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

750 First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 75 kg. Next, set up a proportion: 10/1 = x/75; cross multiply and solve for x, which is 750.

The client with a cerebral aneurysm asks the nurse, "What's the big fuss over a headache?" Which is the best response from the nurse regarding to a cerebral aneurysm? A. "Your physician wants to evaluate the location and condition of the aneurysm." B. "The headache can be an indication that the aneurysm is growing." C. "A headache means your aneurysm is leaking blood into the brain." D. "Don't worry. The aneurysm has probably been there since birth."

Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has history of: a. Seizures or trauma to the brain b. Meningitis during the last 5 years c. Back injury or trauma to the spinal cord d. Respiratory or gastrointestinal infection during the previous month.

Answer D. Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.

A male client is having a lumbar puncture performed. The nurse would plan to place the client in which position? a. Side-lying, with a pillow under the hip b. Prone, with a pillow under the abdomen c. Prone, in slight-Trendelenburg's position d. Side-lying, with the legs pulled up and head bent down onto chest.

Answer D. The client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps open the spaces between the vertebrae.

A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? A. "You'll continue to experience progressive muscle weakness and sensory deficits." B. "The disease is a disorder of motor and sensory dysfunction." C. "This disease doesn't cause sensory impairment." D. "You'll need to take edrophonium (Tensilon) to treat the disease."

Following a motorcycle accident, a client is brought to the emergency department with multiple fractures. Which assessment finding would be most significant in determining the client has also suffered a closed head injury with rising intracranial pressure? A. Nausea B. Blood pressure 100/60 mm Hg C. Lethargy D. Periorbital edema

The client has been brought to the emergency department by their caregiver. The caregiver says that she found the client diaphoretic, nauseated, flushed and complaining of a pounding headache when she came on shift. What are these symptoms indicative of? A. Contusion B. Spinal shock C. Autonomic dysreflexia D. Concussion

The nurse is conducting a focused neurologic assessment and is assessing the client's gag reflex. How should the nurse best perform this aspect of the assessment? A. Observe the client swallowing a small mouthful of water B. Ask the client to swallow a small quantity of any soft food C. Lightly touch the client's pharynx with a cotton swab D. Depress the client's tongue with a sterile tongue depressor

A client comes to the clinic for evaluation because of complaints of dizzinesss and difficulty walking. Further assessment reveals a staggering gait, marked muscle incoordination, and nystagmus. A brain tumor is suspected. Based on the client's assessment findings, the nurse would suspect that the tumor is located in which area of the brain?

Cerebellum

Cerebellum Findings such as ataxic or staggering gait, dizziness, marked muscle incoordination, and nystagmus suggest a cerebellar tumor. A frontal lobe tumor frequently produces personality, emotional, and behavioral changes. A tumor in the motor cortex produces seizurelike movements localized on one side of the body. Occipital lobe tumors produce visual manifestations.

Which of the following diagnostic studies provides visualization of cerebral blood vessels? -Positron emission tomography (PET) -Computer-assisted stereotactic biopsy -Cerebral angiography -Cytologic studies of cerebrospinal fluid (CSF)

Cerebral angiography Cerebral angiography provides visualization of cerebral blood vessels and can localize most cerebral trauma. A PET scan measures the brain's activity and is useful in differentiating tumor from scar tissue or radiation necrosis. Cytologic studies of the cerebral spinal fluid (CSF) may be performed to detect malignant cells because central nervous system tumors can shed cells into the CSF. Computer-assisted stereotactic biopsy is being used to diagnose deep-seated brain tumors.

A client arrives at the ED via ambulance following a motorcycle accident. The paramedics state the client was found unconscious at the scene but briefly regained consciousness during transport to the hospital. Upon initial assessment, the client's GCS score is 7. The nurse anticipates which action? A. Intubation and mechanical ventilation B. An order for a head computed tomography scan C. IV administration of propofol D. Immediate craniotomy

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

A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following? Serotonin Acetylcholine Dopamine Norepinephrine

Dopamine

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

Drugs administered may cause a wide variety of adverse effects. Drugs administered 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.

The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect should the nurse assess this client? Pruritus Dyskinesia Lactose intolerance Diarrhea

Dyskinesia

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

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

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? Discourage the client from doing any range-of-motion (ROM) exercises. Have the client sit up in a chair as much as possible. Logroll the client from side to side. Elevate the head of the bed to 90 degrees.

Logroll the client from side to side.

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

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

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? -Rapid, jerky, involuntary movements -Dementia -Slow, shuffling gait -Dysphagia and dysphonia

Rapid, jerky, involuntary movements The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis? -Hypoactive bowel sounds -Weakness and atrophy of the arm muscles -Sensory deficits in one arm -Severe lower back pain

Severe lower back pain The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) 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.

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? Slows the progression of the disease Replaces dopamine Relieves symptoms of dyskinesia Prevents side effects from carbidopa-levodopa

Slows the progression of the disease

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

Suicidal ideations Severe depression is common and can lead to suicide, so it is most important for the nurse to assess for suicidal ideations. Symptoms of Huntington's disease develop slowly and include mental apathy and emotional disturbances, choreiform movements (uncontrollable writhing and twisting of the body), grimacing, difficulty chewing and swallowing, speech difficulty, intellectual decline, and loss of bowel and bladder control. Assessing for these symptoms is appropriate, but not as important as assessing for suicidal ideations.

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? -Immunotherapy -Surgery -Chemotherapy -Radiation therapy

Surgery A variety of medical treatment modalities, including chemotherapy and external-beam radiation therapy, radiosurgery, or radiotherapy are used alone or in combination with surgical resection. However, surgical intervention provides the best outcome for most brain tumor types.

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

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

Which statement(s) reflect nursing interventions for a client with post-polio syndrome? -The nurse plans patient activities for evening hours rather then morning hours -The nurse provides care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client -The nurse administers antiretroviral agents per order. -The nurse must avoid the use of heat applications in the treatment of muscle and joint pain

The nurse provides care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the client 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. Clientss 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.

The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which plan to use which of the following to test the client's peripheral response to pain? a. Sternal rub b. Nail bed pressure c. Pressure on the orbital rim d. Squeezing of the sternocleidomastoid muscle

Answer B. Motor testing in the unconscious client can be done only by testing response to painful stimuli. Nail bed pressure tests a basic peripheral response. Cerebral responses to pain are tested using sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle.

A female client has a neurological deficit involving the limbic system. Specific to this type of deficit, the nurse would document which of the following information related to the client's behavior. a. Is disoriented to person, place, and time b. Affect is flat, with periods of emotional lability c. Cannot recall what was eaten for breakfast today d. Demonstrate inability to add and subtract; does not know who is president

Answer B. The limbic system is responsible for feelings (affect) and emotions. Calculation ability and knowledge of current events relates to function of the frontal lobe. The cerebral hemispheres, with specific regional functions, control orientation. Recall of recent events is controlled by the hippocampus.

A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? a. Anxiety b. Powerlessness c. Ineffective denial d. Risk for disuse syndrome

Answer B. This comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can't perform even simple daily tasks. Although Anxiety and Risk for disuse syndrome may be diagnoses associated with ALS, the client's comment specifically refers to an inability to act autonomously. A diagnosis of Ineffective denial would be indicated if the client didn't seem to perceive the personal relevance of symptoms or danger.

In which location are most brain angiomas located? -Hypothalamus -Brainstem -Cerebellum -Thalamus

Cerebellum Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).

A client has 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? A Hemorrhage B Skin breakdown C Bowel incontinence D Respiratory dysfunction

A nurse is teaching about ischemic stroke prevention to a community group and emphasizes that control of hypertension, which is the major risk factor for stroke, is key to prevention. Ways to control hypertension include the Dietary Approaches to Stop Hypertension (DASH) diet. This diet includes which of the following? A. High amounts of low-fat dairy products B. Moderate amounts of fruits and vegetables C. Moderate amounts of animal protein D. Moderate amounts of low-fat dairy products

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: A. The tumor rarely spreads to other parts of the body. B. Chemotherapy, following surgery, has recently been shown to be a highly C. effective treatment. D. Surgery can improve survival time but the results are not guaranteed. E. Radiation is not an option because of the tumor's location near the brainstem.

After assessing a client who is in postoperative recovery from surgery to resect a brain tumor, the nurse notes the client is at risk for aspiration. Which nursing intervention should be included in the client's postoperative care plan? A. Position client with head of bed elevated to 45 degrees B. Position client supine with call bell in close reach C. Position client in Trendelenberg with legs raised 15 degrees D. Position client side lying with head of bed elevated to 30 degrees

After striking his head on a tree while falling from a ladder, a client is admitted to the emergency department. He's unconscious and his pupils are nonreactive. Which intervention should the nurse question? A. Giving him a barbiturate B. Elevating the head of his bed C. Placing him on mechanical ventilation D. Performing a lumbar puncture

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? A How to take a bath B How to exercise C How to perform household tasks D How to facilitate tasks such as using both hands to hold a drinking glass

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

D Adrenocorticotropic hormone (ACTH)-producing pituitary adenomas result in Cushing's disease, which is characterized by signs and symptoms that include a "buffalo hump," a rounded face, and striae.

Drugs administered may cause a wide variety of adverse effects.

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.

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. Fluid overload Dysphagia Choking Constipation Anorexia

Dysphagia Choking Constipation

Dysphonia

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that: -Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible. -The tumor will cause pressure on the eighth cranial nerve. -The tumor is malignant and aggressive. -Growth is slow and symptoms are caused by compression rather than tissue invasion.

Growth is slow and symptoms are caused by compression rather than tissue invasion. A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor.

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

Hemorrhagic stroke

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

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? -Have the client sit up in a chair as much as possible. -Logroll the client from side to side. -Elevate the head of the bed to 90 degrees. -Discourage the client from doing any range-of-motion (ROM) exercises.

Logroll the client from side to side. Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.

A nurse is preparing a teaching plan for a client diagnosed with amyotrophic lateral sclerosis (ALS) and his family about the disorder and changes that may occur. Which of the following would the nurse least likely include in the discussion? Spasticity Difficulty swallowing Loss of bladder control Speech difficulties

Loss of bladder control

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? -Calcification of long bones -Osteoarthritis =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.

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

Magnetic resonance imaging (MRI)

Which diagnostic is most commonly used for spinal cord compression?

Magnetic resonance imaging (MRI) pg. 2056

Which topic is most important for the nurse to include in the teaching plan for a client newly diagnosed with Parkinson's disease? Involvement with diversion activities Enhancement of the immune system Establishing balanced nutrition Maintaining a safe environment

Maintaining a safe environment

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

Which term is used to describe edema of the optic nerve? -Scotoma -Papilledema -Angioneurotic edema -Lymphedema

Papilledema Papilledema is edema of the optic nerve. Scotoma is a defect in vision in a specific area in one or both eyes. Lymphedema is the chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary dissection. Angioneurotic edema is a condition characterized by urticaria and diffuse swelling of the deeper layers of the skin.

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

Paralysis 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).

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms?

Parkinson's disease

Which statement indicates appropriate nursing intervention for a client with post-polio syndrome?

Provide care aimed at slowing the loss of strength and maintaining overall well-being.

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

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

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

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

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

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

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

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

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? A. thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes B. after administration of the medication, there will be no change in the status of the ptosis or facial weakness C. the patient will have recovery of symptoms for at least 24 hours after the administration of Tensilon D. eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylecholine and will relieve symptoms

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

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

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

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

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

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

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

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

The nurse is caring for the patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain? A. "I was sitting at home watching television." B. "I was putting my shoes on." C. "I was brushing my teeth." D. "I was taking a bath."

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

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

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? The patient will have unilateral resting tremors and then will have a period of no tremors present. The patient will have a slow, shuffling gait and then will be able to move at a faster pace. The patient will have a period when medication with levodopa will be unnecessary. The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

Tremor, Ridigity, Bradykinesia,Postural instability

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

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

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

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

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

Causative Factors

- genetic link - atherosclerosis - excessive accumulation of oxygen free radicals (important to eat foods high in antioxidants) - viral infections - environmental exposures

The nurse is assessing a client who was brought to the emergency department due to a severe headache with sudden onset, lowered level of consciousness and slurred, non-sensical speech. The client completed chemotherapy and radiation treatment for a glioma-type brain tumor 6 months ago. The client has been taking low molecular weight heparin since completing treatment. The nurse should be prepared to provide care for which possible problem? 1- Intracerebral hemorrhage 2- Deep vein thrombosis 3- Pulmonary embolism 4- Spinal metastasis

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

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

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

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

1,2

A client with an incurable brain tumor is experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply. 1- Ensure that the client is free of pain for meals. 2- Place the client near the sounds and smells of meals being prepared. 3- Plan meals for times when the client is rested. 4- Provide the client with foods that he likes. 5- Prepare the client for the insertion of a feeding tube.

1,3,4

The nurse is providing education to a client who is being discharged with an outpatient treatment plan that includes taking a chemotherapeutic agent. What instructions should the nurse include? Select all that apply. 1- The client should ensure no one else handles the medication. 2- If a dose is missed, the client should take double the amount at the regular time the following day. 3- The client should seek emergency help if nausea or vomiting occur. 4- The client should seek emergency care if he or she develops a fever. 5- Hair loss should be expected when taking the medication.

1,4,5

A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position the patient in what position? 1- In the lithotomy position 2- In a flat side-lying position 3- In the Trendelenburg position 4- In the reverse Trendelenburg position

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

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

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

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

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that: 1- The tumor is malignant and aggressive. 2- The tumor will cause pressure on the eighth cranial nerve. 3- Growth is slow and symptoms are caused by compression rather than tissue invasion. 4- Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

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

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

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

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

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

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

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client? 1- Core needle biopsy 2- Ultrasonography 3- Computed tomography 4- Magnetic resonance imaging

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom? 1- Disruption in sleep patterns 2- Unusual sensitivity to heat and cold 3- Visual disturbances 4- Increased intracranial pressure

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

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

The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond? 1- "I am your nurse and caring for you is my obligation. If you no longer want my care, you have to make a request to my supervisor." 2- "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." 3- "I can see you no longer want me as your nurse today. I will ask one of my colleagues to come in to complete the rest of my assessment." 4- "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."

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

A client is admitted to the hospital after sustaining a closed head injury in a skiing accident. The physician ordered neurologic assessments to be performed every 2 hours. The client's neurologic assessments have been unchanged since admission, and the client is complaining of a headache. Which intervention by the nurse is best? A. Assess the client's neurologic status for subtle changes, administer acetaminophen, and then reassess the client in 30 minutes. B. Reassure the client that a headache is expected and will go away without treatment. C. Administer codeine 30 mg by mouth as ordered and continue neurologic assessments as ordered. D. Notify the physician; a headache is an early sign of worsening neurologic status.

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

Autonomic dysreflexia is an acute emergency that occurs with spinal cord injury as a result of exaggerated autonomic responses to stimuli. Which of the following is the initial nursing intervention to treat this condition? A. Raise the head of the bed and place the patient in a sitting position. B. Empty the bladder immediately. C. Examine the rectum for a fecal mass. D. Examine the skin for any area of pressure or irritation.

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

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

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

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

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

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

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

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

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern? A. take psyllium (Metamucil) daily B. take a laxative whenever bloating is experienced C. adopt a diet with moderate fiber intake D. adopt a high-fiber diet

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

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

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

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

A 58-year-old construction worker fell from a 25-foot scaffolding and incurred a closed head injury as a result. As his intracranial pressure continues to increase, the potential of herniation also increases. If the brain herniates, which of the following are potential consequences? Choose all correct options. A. Impaired cellular activity B. Insomnia C. Seizures D. Death E. Permanent neurologic dysfunction

ADE

Adopt a diet with moderate fiber intake pg.

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern? Take psyllium (Metamucil) daily. Take a laxative whenever bloating is experienced. Adopt a diet with moderate fiber intake. Adopt a high-fiber diet.

Adopt a diet with moderate fiber intake.

14. A patient diagnosed with a pituitary adenoma has arrived on your unit. Based upon your initial assessment, the patient is most likely to exhibit what clinical manifestations? A) Decreased intracranial pressure B) Headache C) Hyperthalamic disorders D) Restlessness

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: Pressures from pituitary adenomas may cause headaches, visual dysfunction, and hypothalamic disorders. Restlessness is not a typical manifestation of pituitary adenomas. Pressure from pituitary adenomas would increase ICP and they would not cause hyperthalmic disorders.

22. The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response? A) Your tumor originated from somewhere outside the CNS. B) Your tumor is pituitary in origin. C) Your tumor originated from cells and structures within the brain. D) Your tumor is from nerve tissue somewhere in your body.

Ans: C Chapter: 65 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: Primary brain tumors originate from cells and structures within the brain. Secondary brain tumors are metastatic tumors that originate somewhere else in the body. The scenario does not indicate that the patient's tumor is a pituitary tumor or a neuroma; therefore options B and D are incorrect.

3. The nurse is writing a care plan for a patient with brain metastases. The nurse decides that an appropriate nursing diagnoses is "Anxiety related to lack of control over the health care needs and situation." In establishing this plan of care for the patient, the nurse will identify which measure as appropriate for the care of this patient? A) The patient will receive anti-anxiety medications every 4 hours. B) The patient's family will be instructed on measures to implement when providing care for the patient. C) The patient will be encouraged to verbalize concerns related to the disease and its treatment. D) The patient will begin a busy schedule of therapy, so that he or she will forget about the anxiety.

Ans: C Chapter: 65 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 1983, Cerebral Metastases Feedback: Patients need the opportunity to exercise some control over their situation. A sense of mastery can be gained as they learn to understand the disease and its treatment and how to deal with their feelings. Distraction, assuming care responsibilities, and administering medications will not allow the patient to gain some control over their situation or discuss their feelings.

28. Because cachexia is common in patients with metastases what is the nurse sure to assess on this patient? A) Sensory function B) Cranial nerves C) Nutritional status D) Motor function

Ans: C Chapter: 65 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1982, Cerebral Metastases Feedback: Nutritional status is assessed, because cachexia (weak and emaciated condition) is common in patients with metastases.

29. A patient with an inoperable brain tumor has been told he is terminal. A referral is made to Home Health. The Home Health Nurse is making a care plan for this patient. What do home care needs and interventions focus on in the terminal patient? A) Assessing cognitive status B) Improving nutritional status C) Promoting mobility D) Assistance in self-care

Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 1983, Cerebral Metastases Feedback: Home care needs and interventions focus on four major areas: palliation of symptoms and pain control, assistance in self-care, control of treatment complications, and administration of specific forms of treatment, such as parenteral nutrition. Assessing cognitive status is not a focus of home care, although it is documented at each visit. Improving nutritional status is a focus with cancer patients who are not terminal. Promoting mobility is not a focus of home care for this patient.

The client with a brain attack (stroke) has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following? a. Giving the client thin liquids b. Thickening liquids to the consistency of oatmeal c. Placing food on the unaffected side of the mouth d. Allowing plenty of time for chewing and swallowing

Answer A. Before the client with dysphagia is started on a diet, the gag and swallow reflexes must have returned. The client is assisted with meals as needed and is given ample time to chew and swallow. Food is placed on the unaffected side of the mouth. Liquids are thickened to avoid aspiration.

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

Respiratory dysfunction 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.

Which patient will the nurse assess for degenerative neurologic symptoms? -The client with glioma. -The client with Huntington disease. -The client with osteomyelitis. -The client with Paget disease.

The client with Huntington disease. Huntington disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Paget disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Malignant glioma is the most common type of brain tumor.

The nurse caring for a patient with bacterial meningitis is administering dexamethasone (Decadron) that has been ordered as an adjunct to antibiotic therapy. When does the nurse know is the appropriate time to administer this medication? A. 1 hour after the antibiotic has infused and daily for 7 days B. 15 to 20 minutes before the first does of antibiotic and ever 6 hours for the next 4 days C. 2 hours prior to the administration of antibiotics for 7 days D. it can be administered every 6 hours for 10 days

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? A. rapid, jerky, involuntary movements B. slow, shuffling gait C. dysphagia and dysphonia D. dementia

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

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

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? 1- "You should ask your physician about that." 2- "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." 3- "You may experience progressive deterioration in all voluntary muscles." 4- "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? 1- Related to visual field deficits 2- Related to difficulty swallowing 3- Related to impaired balance 4- Related to psychomotor seizures

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

Parkinson's Disease

- slowly progressive neurological movement disorder that leads to disability - degenerative or idiopathic most common - symptoms typically appear around 50 - 4th most common neurodegenerative disease - associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal cell ganglia of the brain

Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication? 1- Osteoarthritis 2- Calcification of long bones 3- Pathologic fractures 4- Low bone mass and osteoporosis

A nurse knows that a patient exhibiting seizure like movements localized to one side of the body most likely has what type of tumor? A. a cerebellar tumor B. a frontal lober tumor C. a motor cortex tumor D. an occipital lobe tumor

Client participates in daily hygiene activities with assistive devices.

B, C, D

The nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. What interventions can the nurse provide to assist with relieving the spasms? (Select all that apply.) A. have the patient take a hot tub bath to allow muscle relaxation B. demonstrate daily muscle stretching exercises C. apply warm compresses to the affected areas D. allow the patient adequate time to perform exercises E. assist with a rigorous exercise program to prevent contractures

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

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

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? A. Slows the progression of the disease B. Prevents side effects from carbidopa-levodopa C. Relieves symptoms of dyskinesia D. Replaces dopamine

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? A Explaining hospice care and services B Managing muscle weakness C Offering family support groups D Optimizing nutrition

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

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

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

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

38. You are caring for a patient scheduled for a cervical discectomy tomorrow. You are presenting pre-operative teaching to the patient. Your teaching includes what potential complications? A) Damage to the vocal cords B) Hematoma at the surgical site C) Airway edema D) Hemorrhage

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: Based on all the assessment data, the potential complications may include hematoma at the surgical site, resulting in cord compression and neurologic deficit; and recurrent or persistent pain after surgery.

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

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

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

bradykinesia

abnormally slow voluntary movements and speech

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

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

A patient suspected of having GBS has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? A. glucose in the CSF B. elevated protein levels in the CSF C. red blood cells present in the CSF D. white blood cells in the CSF

30. You are giving an educational presentation at the local senior center on Parkinson's disease. What would you tell the attendees Parkinson's disease is associated with? A) Decreased levels of dopamine B) Decreased levels of hydrocortisol C) Increased levels of hydrocortisone D) Decreased levels of ACTH

Ans: A Chapter: 65 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 4 Page and Header: 1986, Parkinson's Disease Feedback: Parkinson's disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia region of the brain.

37. A patient with amyotrophic lateral sclerosis has been hospitalized on your unit. The patient asks you where he can find some practical information about the disease that is killing him. What resource could you suggest? A) The ALS Association Quarterly Newsletter B) The Amyotrophic Lateral Sclerosis Association C) The National Association of Amyotrophic Lateral Sclerosis D) The International Association Quarterly Newsletter of ALS

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1995, Amyotrophic Lateral Sclerosis Feedback: The ALS Association Quarterly Newsletter is a source of practical information.

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

The nurse is seeing a client who is suspected of having a glioblastoma multiforme tumor. The nurse anticipates the client will require which diagnostic test to confirm the client has this form of brain tumor? 1- Tissue biopsy 2- Weber and Rinne test 3- Audible bruit over the skull 4- An increase in prolactin

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

Following diagnostic testing, a client has been admitted to the ICU and placed on cerebral aneurysm precautions. What nursing action should be included in the client's plan of care? A. Supervise the client's activities of daily living closely. B. Initiate early ambulation to prevent complications of immobility. C. Provide a high-calorie, low-protein diet. D. Perform all of the client's hygiene and feeding.

A patient with amyotrophic lateral sclerosis 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. What medication is the patient referring to? A. Baclofen (Lioresal) B. Riluzole (Rilutek) C. dantrolene sodium (Dantrium) D. diazepam (Valium)

A male client with Bell's palsy asks the nurse what has caused this problem. The nurse's response is based on an understanding that the cause is: a. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem b. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia c. Primary genetic in origin, triggered by exposure to meningitis d. Primarily genetic in origin, triggered by exposure to neurotoxins

Answer A. Bell's palsy is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown, but may include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of these factors.

A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate? "You're doing a great job. Just keep it up." "It must be difficult for you to see your husband like this." "Are you upset about how your husband is doing?" "You sound a bit overwhelmed. Tell me more about what's happening."

"You sound a bit overwhelmed. Tell me more about what's happening."

Causes of Seizure Disorders

- genetic or acquired - hypoxemia - head injury - HTN - infections of CNS - childhood fever - brain tumor - CVA - drug withdrawal

Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's Disease)

- loss of motor neurons (nerve cells controlling muscles) in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem - may be autoimmune or caused from free radical damage - affects more men than women, usually around 50-60

Symptoms of Alzheimer's Disease

- memory loss - decline in ability to perform routine tasks - disorientation - impaired judgement - personality changes - loss of communication and language skills

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient? 1- Paclitaxel 2- Coumadin 3- Decadron 4- Dilantin

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse followed a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize the patient most likely has? A. benign B. primary progressive C. relapsing-remitting (RR) D. disabling

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? A. lumbar sacral pain B. the development of a skin ulcer from the radiation C. hematoma formation D. spinal metastasis

The nurse is working on a surgical floor. The nurse must logroll a male client following a: a. laminectomy. b. thoracotomy. c. hemorrhoidectomy. d. cystectomy.

Answer A. 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.

Coumadin pg. 2057

6. The parents of a child with muscular dystrophy have the desire to gain additional information regarding services available to children and families affected by this condition. They call the clinic nurse and ask for advice. The nurse's best response is to provide information to the parents related to what? A) Spiritual counseling B) The Muscular Dystrophy Association C) Programs offered by the local school district D) The American Academy of Pediatrics

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 6 Page and Header: 1996, Muscular Dystrophies Feedback: While all options will serve to provide a varying level of support to the child and the family, the Muscular Dystrophy Association will provide information specific to programs of patient services and clinical care, research initiatives, and professional and public education.

21. The pathophysiology instructor is discussing neoplasms with the pre-nursing students. The instructor explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue. The physiologic changes that result cause what pathophysiologic events? (Mark all that apply.) A) Fatigue B) Slurred speech C) Increased ICP D) Focal neurologic signs E) Altered pituitary function

Ans: C, D, E Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: The effects of neoplasms are caused by the compression and infiltration of tissue. A variety of physiologic changes result, causing any or all of the following pathophysiologic events: increased intracranial pressure (ICP) and cerebral edema, seizure activity and focal neurologic signs, hydrocephalus, and altered pituitary function.

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

Ans: D Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Option A is incorrect since fluid overload isn't specifically related to Parkinson's disease and, although drooling occurs with Parkinson's disease, it doesn't take priority. Anorexia (option B) and diarrhea (option C) aren't specifically associated with Parkinson's disease.

40. A nurse is planning discharge teaching for a patient who underwent a cervical diskectomy. Part of the discharge process is for the nurse to assess the patient's understanding of certain management strategies. What strategies would the nurse assess that would aid her in planning discharge teaching? A) Care of the cervical collar B) Regimen for rest C) Signs and symptoms that need to be reported to the home health nurse D) How to assess vital signs

Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 2000, Herniation of a Cervical Intervertebral Disk Feedback: The nurse assesses the patient's understanding of these management strategies, limitations, and recommendations: strategies for pain management; signs and symptoms that may indicate complications that should be reported to the physician; use and care of the cervical collar; and to alternate tasks that involve minimal body movement (eg, reading) with tasks that require greater body movement. The assessment of vital signs, regimen for rest, and signs and symptoms to report to the home health nurse would not need to be assessed to aid the nurse in planning discharge teaching.

The nurse is assigned to care for a female client with complete right-sided hemiparesis. The nurse plans care knowing that this condition: a. The client has complete bilateral paralysis of the arms and legs. b. The client has weakness on the right side of the body, including the face and tongue. c. The client has lost the ability to move the right arm but is able to walk independently. d. The client has lost the ability to move the right arm but is able to walk independently.

Answer B. Hemiparesis is a weakness of one side of the body that may occur after a stroke. Complete hemiparesis is weakness of the face and tongue, arm, and leg on one side. Complete bilateral paralysis does not occur in this condition. The client with right-sided hemiparesis has weakness of the right arm and leg and needs assistance with feeding, bathing, and ambulating.

Alzheimer's Disease

- progressive degenerative disease that attacks the brain and results in impaired memory, thinking, behavior - most common form of dementia affecting over 4 million Americans - fourth leading cause of death in adults

Which of the following is a late symptom of spinal cord compression? A Paralysis B Fecal incontinence C Urinary incontinence D Urinary retention

A, B, C

A patient is diagnosed with an intracerebral tumor. The nurse knows that the diagnosis may include which of the following? (Select all that apply.) A. astrocytoma B. ependymoma C. medulloblastoma D. meningioma E. acoustic neuroma

A patient with Bell's palsy says to the nurse "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient? A. suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone B. suggest applying cool compresses on the face several times a day to tighten the muscle C. inform the patient that the muscle function will return as soon as the virus dissipates D. tell the patient to smile every 4 hours

A patient with myasthenia gravis is in the hospital for the treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) 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? A. the muscles will become fatigued and the patient will not be able to chew food or swallow pills B. there should not be a problem, since the medication was only delayed about 2 hours C. the patient will go into cardiac arrest D. the patient will require a double dose prior to lunch

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

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

A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? a. "You may have difficulty believing this, but the paralysis caused by this disease is temporary." b. "You'll have to accept the fact that you're permanently paralyzed. However, you won't have any sensory loss." c. "It must be hard to accept the permanency of your paralysis." d. "You'll first regain use of your legs and then your arms."

Answer A. The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.

Which of the following teaching points is a priority in the management of symptoms for a client with Bell's palsy? A. Encourage semiannual dental exams. B. Complete the course of antibiotics as prescribed. C. Use ophthalmic lubricant and protect the eye. D. Avoid stimuli that trigger pain.

Which assessment finding is most important in determining nursing care for a client with bacterial meningitis? Select all that apply. A. Low red blood cell (RBC) count B. Pain and stiffness of the extremities C. Purpura of hands and feet D. Cloudy cerebral spinal fluid E. Low white blood cell (WBC) count F. Low antidiuretic hormone (ADH) levels

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

Prepare an advance directive.

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

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

The nurse is administering the IV antiviral medication ganciclovir (Cytovene) to the patient with HSV-1 encephalitis. What is the best way for the nurse to administer the medication to avoid crystallization of the medication in the urine? A. Administer the medication rapidly over 15 minutes with 100 mL of normal saline. B. Dilute the medicine in 500 mL of lactated Ringer's solution C. Administer via slow IV over 1 hour D. Administer in a drip over 4 hours

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

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

1,2,3

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

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

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? A. the patient will have unilateral testing tremors and then will have a period of no tremors present B. the patient will have a slow, shuffling gait and then will be able to move at a faster pace C. the patient will have a period when medication with levodopa will be unnecessary D. the patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication

8. A patient with Parkinson's disease is undergoing a swallow study because she is experiencing difficulties when swallowing. What consistency is most appropriate for this patient to reduce the risk of aspiration? A) Solid food with thin liquids B) Pureed food with water C) Semisolid food with thick liquids D) Thin liquids only

Ans: C Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: A semisolid diet with thick liquids is easier to swallow for a patient with swallowing difficulties than a solid diet. Thin liquids should be avoided. Pureed foods with water are not indicated for this patient.

The nurse is conducting a preoperative assessment of a client who is scheduled for surgical removal of a primary spinal tumor. What should the nurse include in the preoperative session? Select all that apply. A. Preparing to transition to palliative care B. Question about current bowel and bladder control C. Methods of pain control after surgery D. Adjusting to changes in daily activities E. Ensuring privacy of client information from family members

BCD

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

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

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

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

Medical Management of Parkinson's Disease

- pharmacological: levodopa, anticholinergics, antivirals like symmetrel, MAOIs, antidepressants - surgical: ventrolateral portions of the thalamus and medial globus pallidus are destroyed to reduce tremor, rigidity, bradykinesia - stem cell transplant: adrenal medullary tissue

Nursing Management of Alzheimer's Disease

- support cognitive function - promote physical safety - reduce anxiety and agitation - improve communication - promote independence in self care - provide for socialization and intimacy needs - promote adequate nutrition - promote balanced activity and rest - provide family support, respite care, adult day care

Cardinal Signs of Parkinson's Disease

- tremor: resting tremor that occurs with purposeful movement - rigidity: resistance to passive limb movement causing jerky movements or cogwheeling; increases to passive limb when the other extremity is engaged in voluntary active movement - bradykinesia: difficulty initiating movement and takes longer to complete tasks - postural instability

A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approved for the treatment of this symptom? 1- Tetrabenazine (Xenazine) 2- Carbamazepine (Tegretol) 3- phenobarbital 4- Diazepam (Valium)

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

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

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

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

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

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

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

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

Ans: A, B, C Chapter: 65 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1993, Huntington Disease Feedback: The Huntington's Disease Foundation of America helps patients and families by providing information, referrals, family and public education, and support for research. It does not provide individual assessments or exclusion from research studies.

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

Ans: B Chapter: 65 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 1988, Parkinson's Disease Feedback: Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.

31. A patient, brought to the clinic by his son, is diagnosed with Huntington's disease. The son asks what causes his father to do the things he does. What would be the nurse's best response? A) "Your father's brain is slowly rebuilding the area called the striatum." B) "Your father's brain is trying to rebuild the area of the brain that controls movement." C) "Your father's brain is dying in the area of the brain that controls movement." D) "Your father's brain is dying and there is nothing we can do about it."

Ans: C Chapter: 65 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 1992, Huntington Disease Feedback: The basic pathology involves premature death of cells in the striatum (caudate and putamen) of the basal ganglia, the region deep within the brain that is involved in the control of movement.

A female client is admitted in a disoriented and restless state after sustaining a concussion during a car accident. Which nursing diagnosis takes highest priority in this client's plan of care? a. Disturbed sensory perception (visual) b. Self-care deficient: Dressing/grooming c. Impaired verbal communication d. Risk for injury

Answer D. Because the client is disoriented and restless, the most important nursing diagnosis is risk for injury. Although the other options may be appropriate, they're secondary because they don't immediately affect the client's health or safety.

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 A. Clients with Parkinson's disease shouldn't have liquids; remove them from the dinner tray before serving food to the client. B. Make sure the client is sitting with the head of bed elevated to 90 degrees. C. Assist the client into a comfortable position and stay alert for coughing, which signifies aspiration. D. There are no special precautions for the client with Parkinson's disease.

A nurse is caring for a client with L1-L2 paraplegia who is undergoing rehabilitation. Which goal is appropriate? A. Establishing an ambulation program using short leg braces B. Preventing autonomic dysreflexia by preventing bowel impaction C. Establishing an intermittent catheterization routine every 4 hours D. Managing spasticity with range-of-motion exercises and medications

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

A client who has experienced an ischemic stroke has been admitted to the medical unit. The client's family is adamant that she remain on bed rest to hasten her recovery and to conserve energy. What principle of care should inform the nurse's response to the family? (Ch. 47 pg. 1370)A. The client should remain on bed rest until she expresses a desire to mobilize. B. To prevent contractures and muscle atrophy, bed rest should not exceed 4 weeks. C. Lack of mobility will greatly increase the client's risk of stroke recurrence. D. The client should mobilize as soon as she is physically able.

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

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

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

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery? 1- Cerebrospinal fluid leakage 2- Infection at the surgical site 3- Growth of a secondary tumor 4- Impaired tissue healing

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

35. A patient, newly diagnosed with Parkinson's disease, is expecting to be discharged home in the morning. When interacting with the patient during discharge teaching, the patient asks for direction to resources she and her family can access. What is resource you would give her? A) International Association of Degenerative Diseases B) American Association of Degenerative Diseases C) American Parkinson's Disease Association D) International Parkinson's Foundation, Inc.

Ans: C Chapter: 65 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1991, Parkinson's Disease Feedback: Information booklets and a newsletter for patient education are published by the National Parkinson's Foundation, Inc., and the American Parkinson's Disease Association. That makes options A, B, and D incorrect.

During a routine physical examination to assess a male client's deep tendon reflexes, the nurse should make sure to: a. use the pointed end of the reflex hammer when striking the Achilles tendon. b. support the joint where the tendon is being tested. c. tap the tendon slowly and softly d. hold the reflex hammer tightly.

Answer B. To prevent the attached muscle from contracting, the nurse should support the joint where the tendon is being tested. The nurse should use the flat, not pointed, end of the reflex hammer when striking the Achilles tendon. (The pointed end is used to strike over small areas, such as the thumb placed over the biceps tendon.) Tapping the tendon slowly and softly wouldn't provoke a deep tendon reflex response. The nurse should hold the reflex hammer loosely, not tightly, between the thumb and fingers so it can swing in an arc.

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

"Let's explore other options, because laxatives can have side effects and create dependency."

The nurse is providing care for a client who just discussed palliative care with the primary health care provider. The client's family member was also part of the discussion and asks the nurse, "I feel like this kind of treatment means we've given up on trying." How should the nurse respond? Choose the best option. "The goal of this type of care is to promote the best quality of life that is now possible." "This is your best option considering the end is near for the client. " "You are not giving up. Unfortunately the tumor has won the fight." "The prognosis for the client is poor, so it would be wasteful to provide any more aggressive treatment."

"The goal of this type of care is to promote the best quality of life that is now possible."

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?

"The surgeon will be able to remove all of the tumor." pg. 2053

The nurse is caring for a client who was diagnosed with a glioma 5 months ago. Today, the client was brought to the emergency department by his caregiver because he collapsed at home. The nurse suspects late signs of rising intracranial pressure (ICP) when which blood pressure and pulse readings are noted? 1- BP = 90/50 mm Hg; HR = 75 bpm 2- BP =130/80 mm Hg; HR = 55 bpm 3- BP = 150/90 mm Hg; HR = 90 bpm 4- BP = 175/45 mm Hg; HR = 42 bpm

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

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

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? A. increased intracranial pressure B. dehydration C. migraines D. the tumor is shrinking

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

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

The nurse is planning to provide education about prevention in the community YMCA due to the increase in numbers of spinal cord injuries (SCIs). What predominant risk factors does the nurse understand will have to be addressed? Select all that apply. A. Male gender B. Older adult C. Substance abuse D. Low-income community E. Young age

ACE

The nurse has given the male client with Bell's palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will: a. Exposure to cold and drafts b. Massage the face with a gentle upward motion c. Perform facial exercises d. Wrinkle the forehead, blow out the cheeks, and whistle

Answer A. Prevention of muscle atrophy with Bell's palsy is accomplished with facial massage, facial exercises, and electrical stimulation of the nerves. Exposure to cold or drafts is avoided. Local application of heat to the face may improve blood flow and provide comfort.

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer? A Esophageal carcinoma B Pituitary carcinoma C Laryngeal carcinoma D Colorectal carcinoma

What should be included in the client's care plan when establishing an exercise program for a client affected by a stroke? A. Have the client perform active range-of-motion (ROM) exercises once a day. B. Exercise the affected extremities passively four or five times a day. C. Schedule passive range of motion every other day. D. Keep activity limited, as the client may be overstimulated

The nurse is caring for a client after lumbar puncture. The client reports a severe headache. Which actions should the nurse complete? Select all that apply. A. Position the client in the supine position. B. Administer analgesic medication. C. Administer fluids to the client. D. Maintain the client on bed rest. E. Prepare for an epidural blood patch.

BCD

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 if the client has had a bowel movement. -Have the client lie on the back and lift the leg, keeping it straight. -Ask the client if there is pain on ambulation. -Ask if the client can walk.

Have the client lie on the back and lift the leg, keeping it straight. A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc?

Have the client lie on the back and lift the leg, keeping it straight. pg. 2074

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

Hematoma at the surgical site

While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? Page the health care provider and report this sign of infection. Reinforce the dressing and reassess in 1 to 2 hours. Reposition the client to prevent further hemorrhage. Inform the surgeon of the possibility of a dural leak.

Inform the surgeon of the possibility of a dural leak.

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

Irritation of the meduallary vagal centers Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.

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? -Removing the entire collar when shaving -Wearing the cervical collar when sleeping -Moving the neck from side to side when the collar is off -Keeping the head in a neutral position

Keeping the head in a neutral position 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.

The nurse is caring for a patient with Parkinson's disease and is preparing to administer medication. What does the nurse administer to the patient that is considered the most effective drug currently given for the tremor of Parkinson's? Requip Levodopa Symmetrel Permax

Levodopa

Which medication is the most effective agent in the treatment of Parkinson disease? Benztropine Amantadine Levodopa Bromocriptine mesylate

Levodopa

Logroll the client from side to side.

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.

Mannitol

A client with a herniated lumbar disc has asked about nonsurgical strategies to help with mobility. What strategies will the nurse teach the client? Select all that apply. Muscle relaxants Weight reduction Physical therapy Hydrotherapy Nonsteroidal anti-inflammatory medications Positive feedback and attitude

Muscle relaxants Weight reduction Physical therapy Nonsteroidal anti-inflammatory medications

Parkinson's disease

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

Parkinsons disease

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

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

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

25. A 16-year-old male patient presents at the free clinic with complaints of impotency. Upon physical examination the physician finds hypogonadism. What would the nurse know is the suspected diagnosis? A) Prolactinoma B) Angioma C) Glioma D) Adrenocorticotropic hormone (ACTH)-producing adenoma

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: Male patients with prolactinomas may present with impotence and hypogonadism. An adrenocorticotropic hormone (ACTH)-producing adenoma would cause acromegaly. There is not enough information in the scenario to know if the tumor is an angioma, glioma, or neuroma.

The nurse is assessing the adaptation of the female client to changes in functional status after a brain attack (stroke). The nurse assesses that the client is adapting most successfully if the client: a. Gets angry with family if they interrupt a task b. Experiences bouts of depression and irritability c. Has difficulty with using modified feeding utensils d. Consistently uses adaptive equipment in dressing self

Answer D. Clients are evaluated as coping successfully with lifestyle changes after a brain attack (stroke) if they make appropriate lifestyle alterations, use the assistance of others, and have appropriate social interactions. Options A, B, and C are not adaptive behaviors.

A 76-year-old client is brought to the clinic by his daughter. The daughter states that her father has had two transient ischemic attacks (TIAs) in the past week. The physician orders carotid angiography, and the report reveals that the carotid artery has been narrowed by atherosclerotic plaques. What treatment option does the nurse expect the physician to offer this client to increase blood flow to the brain? A. Stent placement B. Removal of the carotid artery C. Percutaneous transluminal coronary artery angioplasty D. Carotid endarterectomy

A client is postoperative day 1 following intracranial surgery. The nurse's assessment reveals that the client's LOC is slightly decreased compared with the day of surgery. What is the nurse's best response to this assessment finding? A. Alert the surgeon to the possibility of an intracranial hemorrhage. B. Understand that the surgery may have been unsuccessful. C. Recognize the need to refer the client to the palliative care team. D. Recognize that this may represent the peak of postsurgical cerebral edema.

The nurse is caring for a patient with increased intracranial pressure (ICP) caused by a traumatic brain injury. Which of the following clinical manifestations would indicate that the patient is experiencing increased brain compression causing brainstem damage? A. Hyperthermia B. Bradypnea C. Tachycardia D. Hypertension

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

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

33. The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goals? A) Developing positive coping mechanisms B) Controlling diarrhea C) Decreasing hyperactivity D) Alteration in nutrition

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: The goals for the patient may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Option E is incorrect; it is a nursing diagnosis, not a goal. Parkinson's patients are constipated, so option B is incorrect. Mobility is a problem, not hyperactivity.

32. Researchers are working on finding out just what the process is that initiates neurodegeration in diseases like Huntington's disease and multiple sclerosis. The current thought is that neurodegeneration is the result of what? A) Oxidative stress on the substantia nigra B) Protein aggregation on Lewy bodies C) Protein aggregation on the substantia nigra D) Oxidative stress on Lewy bodies

Ans: D Chapter: 65 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1992, Huntington Disease Feedback: Researchers are working on uncovering the exact mechanism of neurodegeneration; current theories suggest that it results from oxidative stress in a portion of the neuron known as Lewy bodies, protein aggregation, or a combination of the two mechanisms

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

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

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

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

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

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

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

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

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

A female client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? a. Giving client full control over care decisions and restricting visitors b. Providing positive feedback and encouraging active range of motion c. Providing information, giving positive feedback, and encouraging relaxation d. Providing intravaneously administered sedatives, reducing distractions and limiting visitors

Answer C. The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client's condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.

A nurse is discussing a lumbar puncture with a nursing student who observed the procedure. The student noticed that the cerebrospinal fluid was blood tinged and asks what that means. The correct reply is which of the following? A. "It can mean the spinal cord was damaged or a traumatic puncture." B. "It can mean a traumatic puncture or a subarachnoid bleed." C. "It can mean a subarachnoid bleed or damage to the spinal cord." D. "It can mean a bleed around the hypothalamus or damage from the needle."

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

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

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

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

16. The nurse in an extended care facility is planning the daily activities of a patient with postpolio syndrome. The nurse recognizes the patient will best benefit from physical therapy when it is scheduled at what time? A) Immediately after lunch B) In the morning C) Two times a day D) Immediately prior to dinner

Ans: B Chapter: 65 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 2003, Postpolio Syndrome Feedback: Important activities for patients with postpolio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening. Therefore options A, C, and D are incorrect.

17. A patient newly diagnosed with a cervical disk herniation is involved in patient teaching with the clinic nurse. What conservative management measures will the nurse teach the patient to implement? A) Increase daily activity B) Sleep on a firm mattress C) Apply cool compresses to the back of the neck daily D) Wear the cervical collar when the pain begins to resolve

Ans: B Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 2001, Herniation of a Cervical Intervertebral Disk Feedback: Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic relief from pain. The patient may need to wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disk herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.

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

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

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

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

10. A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. The family should be aware that the neurologic signs and symptoms of metastatic brain disease are what? A) Bradycardia B) Temperature greater than 100.5°F C) Increase in diastolic blood pressure D) Personality changes

Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 1977, Primary Brain Tumors Feedback: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. These problems can be devastating to both patient and family. Bradycardia, elevated temperature, and an increase in diastolic blood pressure are not neurologic signs and symptoms of metastatic brain disease.

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

A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test? a. Immobilize the neck before the client is moved onto a stretcher. b. Determine whether the client is allergic to iodine, contrast dyes, or shellfish. c. Place a cap over the client's head. d. Administer a sedative as ordered.

Answer B. Because CT commonly involves use of a contrast agent, the nurse should determine whether the client is allergic to iodine, contrast dyes, or shellfish. Neck immobilization is necessary only if the client has a suspected spinal cord injury. Placing a cap over the client's head may lead to misinterpretation of test results; instead, the hair should be combed smoothly. The physician orders a sedative only if the client can't be expected to remain still during the CT scan.

Nurse Kristine is trying to communicate with a client with brain attack (stroke) and aphasia. Which of the following actions by the nurse would be least helpful to the client? a. Speaking to the client at a slower rate b. Allowing plenty of time for the client to respond c. Completing the sentences that the client cannot finish d. Looking directly at the client during attempts at speech

Answer C. Clients with aphasia after brain attack (stroke) often fatigue easily and have a short attention span. General guidelines when trying to communicate with the aphasic client include speaking more slowly and allowing adequate response time, listening to and watching attempts to communicate, and trying to put the client at ease with a caring and understanding manner. The nurse would avoid shouting (because the client is not deaf), appearing rushed for a response, and letting family members provide all the responses for the client.

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

13. A 13-year-old patient is admitted to the adolescent unit with a suspected brain tumor. The patient asks the nurse which diagnostic test is the most helpful in the diagnosis of brain tumors. What is the nurse's best response? A) Computed tomography (CT) scan B) Magnetic resonance imaging (MRI) C) Brain biopsy D) Blood work with (ACTH) levels

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1979, Primary Brain Tumors Feedback: An MRI is the most helpful in the diagnosis of brain tumors. Its use has resulted in the detection of smaller lesions; it is particularly helpful in detecting tumors in the brainstem and pituitary regions, where bone interferes with CT. A brain biopsy and blood work with ACTH levels do not diagnose brain tumors.

15. A male patient with a metastatic brain tumor has a generalized seizure. He is vomiting. The family calls for the nurse. What should the nurse do first? A) Obtain supplies to suction. B) Page or call the physician. C) Insert a wooden tongue blade into his mouth. D) Turn him on his side.

Ans: D Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1981, Primary Brain Tumors Feedback: The nurse's first response should be to place the patient on his side to prevent him from aspirating emesis. Inserting something into the seizing patient's mouth is no longer part of a seizure protocol. Obtaining supplies to suction the patient would be a delegated task. Paging or calling the physician would only be necessary if this is the patient's first seizure.

A 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? -"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." -"You should ask your physician about that." -"This form of muscular dystrophy is a relatively benign disease that progresses slowly."

"You may experience progressive deterioration in all voluntary muscles." 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.

Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting? A. The client will remain free of injury if a seizure does occur. B. The client will verbalize an understanding of feelings that preempt seizure activity. C. The client will post emergency numbers on the refrigerator for ease of obtaining. D. The client will take the seizure medication at the same time daily.

Thyroid-stimulating hormone

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

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

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

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

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

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

39. You are covering patients for a nurse who is at dinner. One of those patients had a cervical diskectomy earlier today. The patient calls you to her room and tells you she is having severe pain and that it came on suddenly. What would you do? A) Call for an entubation tray B) Take the bandage off C) Call the surgeon D) Increase their pain medicine

Ans: C Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: If the patient experiences a sudden increase in pain, extrusion of the graft may have occurred, requiring reoperation. A sudden increase in pain should be promptly reported to the surgeon. You would not call for an entubation tray; if the procedure was an anterior cervical diskectomy the entubation tray should already be in the room. Taking the bandage off is only done at the surgeon's order, as is increasing the pain medicine.

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

Ans: D Chapter: 64 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1991, Parkinson's Disease Feedback: Nursing interventions for a patient who has inadequate nutritional intake should include the following: Apply deep gentle pressure around the patient's mouth to assist with swallowing, and administer phenothiazines prior to the patient's meal as ordered. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the patient during feeding are uncontrollable choreiform movements and should not be interrupted.

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: a. Eating large, well-balanced meals b. Doing muscle-strengthening exercises c. Doing all chores early in the day while less fatigued d. Taking medications on time to maintain therapeutic blood levels

Answer D. Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.

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

Client participates in activities of daily living using adaptive devices. pg. 2072

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

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

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

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

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

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

24. The nursing instructor is talking with the junior nursing class about glial cell tumors. The instructor tells the students that the most common type of glioma is an astrocytoma and that astrocytomas are graded from I to IV, indicating the degree of malignancy. What would the instructor tell the students the grade is based on? A) Cellular density, number of cells, and appearance B) Size of cells, number of cells, and appearance C) Cellular density, cell mitosis, and appearance D) Cell mitosis, size of cells, and appearance

Ans: C Chapter: 65 Client Needs: A-1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1976, Primary Brain Tumors Feedback: Astrocytomas are the most common type of glioma and are graded from I to IV, indicating the degree of malignancy. The grade is based on cellular density, cell mitosis, and appearance. Usually, these tumors spread by infiltrating into the surrounding neural connective tissue and therefore cannot be totally removed without causing considerable damage to vital structures. The grading of the tumor is not based on the size of the cells or the number of cells.

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

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

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

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

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

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

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

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

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

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

23. A nurse on the oncology unit is caring for a patient with an astrocytoma. The patient has just been told that the tumor is growing very fast. The patient asks the nurse how these tumors grow. What would be the nurse's best response? A) "Astrocytomas infiltrate the surrounding neural connective tissue." B) "Astrocytomas grow by invading the surrounding gray matter." C) "Astrocytomas grow by invading the surrounding white matter." D) "Astrocytomas spread down the spinal cord." al structures. Astrocytomas invade both the gray and white matter indiscriminately, and will grow down the spinal cord if they spread far enough. These answers are not the most correct.

Ans: A Chapter: 65 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1976, Primary Brain Tumors Feedback: Usually, astrocytomas spread by infiltrating into the surrounding neural connective tissue, and therefore cannot be totally removed without causing considerable damage to vital structures. Astrocytomas invade both the gray and white matter indiscriminately, and will grow down the spinal cord if they spread far enough. These answers are not the most correct.

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

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. The patient with an acoustic neuroma usually experiences loss of hearing, tinnitus, and episodes of vertigo and staggering gait. Acoustic neuromas do not cause loss of vision, increased sodium retention, or tachycardia.

4. A patient with suspected Parkinson's disease is being initially assessed by the nurse. The nurse would expect the patient to have a tremor. When is the best time to assess for the tremor? A) During a period of time when the patient is resting B) During a period of time when the patient is brushing the teeth C) During a period of time when the patient is preparing his or her meal tray to eat D) During a period of time when the patient is participating in occupational therapy

Ans: A Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1986, Parkinson's Disease Feedback: The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement but is evident when the extremities are motionless. Therefore options B, C, and D are incorrect.

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

Ans: B Chapter: 65 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1985, Spinal Cord Tumors Feedback: After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The lithotomy position, Trendelenberg position, and reverse Trendelenberg position are inappropriate for this patient.

34. You are caring for a patient diagnosed with Parkinson's disease. Your patient is having increasing problems with rising from the sitting to the standing position. What would you suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? A) A handicapped toilet B) A raised toilet seat C) Sit quietly on the toilet every 2 hours D) Follow the outlined bowel program

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1990, Parkinson's Disease Feedback: A raised toilet seat is useful, because the patient has difficulty in moving from a standing to a sitting position. A handicapped toilet is not high enough and will not aid in improving bowel elimination. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position; neither will following the outlined bowel program.

20. A patient with amyotrophic lateral sclerosis (ALS) is being visited by the Home Health Nurse. The nurse is creating a care plan for this patient. What nursing diagnosis is appropriate for a patient with this condition? A) Chronic confusion B) Impaired urinary elimination C) Impaired verbal communication D) Bowel incontinence

Ans: B Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1995, Amyotrophic Lateral Sclerosis Feedback: Impaired communication is an appropriate nursing diagnosis, as the voice in patients with ALS assumes a nasal sound, and articulation becomes so disrupted that speech is unintelligible. Intellectual function is not impaired in patients with ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that control muscles of the rectum and urinary bladder are not affected.

26. The oncology staff educator is precepting a graduate nurse. They are admitting a 77-year-old female patient with a diagnosis of stage IV astrocytoma. The graduate nurse asks how long the lady has known she has cancer. What would be the staff educator's best response? A) "She hasn't known very long because she is pretty good at hiding things that change from her family." B) "She hasn't known very long because an early sign is personality change and elderly people don't know that their personality has changed." C) "She hasn't known very long because early signs and symptoms of intracranial tumors can be overlooked in the elderly because people think they are the result of normal aging." D) "She hasn't known very long because elderly people have a tendency not to go to the doctor when early signs and symptoms appear."

Ans: C Chapter: 65 Client Needs: B Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 1977, Primary Brain Tumors Feedback: In elderly patients, early signs and symptoms of intracranial tumors can be easily overlooked or incorrectly attributed to cognitive and neurologic changes associated with normal aging.

9. While assessing the patient at the beginning of the shift the nurse inspects a surgical dressing covering the operative site after the patients' cervical discectomy. The nurse notes the drainage is serosanguineous. The nurse recognizes that the characteristic of this drainage may indicate what? A) Abnormal finding B) Postnasal drainage C) Hemorrhage D) A dural leak

Ans: D Chapter: 65 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 1999, Herniation of a Cervical Intervertebral Disk Feedback: After a cervical discectomy, the nurse will monitor the operative site and dressing covering this site. Serosanguineous drainage may indicate a dural leak. This is not an abnormal finding, postnasal drip, or an indication of hemorrhage.

The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to: a. take a hot bath. b. rest in an air-conditioned room c. increase the dose of muscle relaxants. d. avoid naps during the day

Answer B. Fatigue is a common symptom in clients with multiple sclerosis. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue. Planning for frequent rest periods and naps can relieve fatigue. Other measures to reduce fatigue in the client with multiple sclerosis include treating depression, using occupational therapy to learn energy conservation techniques, and reducing spasticity.

The nurse is caring for the male client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated? a. Loosening restrictive clothing b. Restraining the client's limbs c. Removing the pillow and raising padded side rails d. Positioning the client to side, if possible, with the head flexed forward

Answer B. Nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising side rails in the bed, and placing the client on one side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible, protects the head from injury, and moves furniture that may injure the client. Other aspects of care are as described for the client who is in bed.

A female client admitted to the hospital with a neurological problem asks the nurse whether magnetic resonance imaging may be done. The nurse interprets that the client may be ineligible for this diagnostic procedure based on the client's history of: a. Hypertension b. Heart failure c. Prosthetic valve replacement d. Chronic obstructive pulmonary disorder

Answer C. The client having a magnetic resonance imaging scan has all metallic objects removed because of the magnetic field generated by the device. A careful history is obtained to determine whether any metal objects are inside the client, such as orthopedic hardware, pacemakers, artificial heart valves, aneurysm clips, or intrauterine devices. These may heat up, become dislodged, or malfunction during this procedure. The client may be ineligible if significant risk exists.

NUR 211 Wk 8 - Management of Patients with Oncologic or Degenerative Neurologic Disorders

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