Chapter 44: Nursing Management: Patients With Oncologic Disorders of the Brain and Spinal Cord
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? - Computed tomography (CT) scan - Brain biopsy - Magnetic resonance imaging (MRI) - Blood work with adrenocorticotropic hormone (ACTH) levels
Correct response: Magnetic resonance imaging (MRI) Explanation: 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 or blood work with ACTH levels does not diagnose brain tumors.
A client with a brain tumor is exhibiting papilledema. When reviewing the client's history, which information would the nurse correlate with this finding? Select all that apply. - Double vision - Aphasia - Swaying gait - Visual field deficit - Enhanced visual acuity
Correct response: - Double vision - Visual field deficit Explanation: Papilledema is associated with visual disturbances, such as decreased visual acuity, diplopia (double vision), and visual field deficits. It is not associated with a swaying gait or aphasia.
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. - Staggering gait - Visual hallucinations - Abnormal eye movements - Muscle incoordination - Apathetic mental attitude
Correct response: - Staggering gait - Muscle incoordination - Abnormal eye movements Explanation: A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction. Visual hallucination are associated with occipital lobe tumors. An apathetic mental attitude can manifest from a tumor in the motor cortex of the frontal lobe.
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
Ans: 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.
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
Ans: A) Falls 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.
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
Ans: A, B, D, E A)Pain control B)Management of treatment complications D)Assistance with self-care E)Administration of treatments 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 nurse begins an assessment interview of a patient with a brain tumor. The patient describes her headaches. The nurse expects to hear specific terms that describe her symptoms. Which of the following best describe the symptoms of her headache? Select all that apply. - Is made worse with coughing and sudden movement - May improve with vomiting - Is intermittent and diminishes with rest - Is unrelenting - Occurs most frequently in the early morning
Correct response: - Occurs most frequently in the early morning - Is unrelenting - Is made worse with coughing and sudden movement - May improve with vomiting Explanation: Characteristic indicators of an intracerebral headache are a headache that occurs in the early morning; is made worse by coughing, straining, or sudden movement; and may improve with vomiting. It is described as deep, dull, and unrelenting.
The nurse is caring for a client who is currently under medical investigation for a pituitary adenoma. The nurse anticipates the client will likely report which symptoms that are consistent with this type of brain tumor? Select all that apply. - Impairment of visual field - Seizures - Polyuria - Disturbed sleep - Polydipsia
Correct response: - Polydipsia - Polyuria - Disturbed sleep - Impairment of visual field Explanation: Pressure from a pituitary adenoma may be exerted on the optic nerves, optic chiasm, optic tracts, hypothalamus, or the third ventricle. Headache is a common symptom; there can also be visual dysfunction including loss of visual field, the development of diabetes insipidus including symptoms such as excessive thirst and urination. Sleep disturbances are reported and result from the development of diabetes insipidus. Seizures are a common finding with angioma brain tumors.
Which of the following are clinical manifestations associated with increased intracranial pressure (ICP)? Select all that apply. - Headache - Angina - Nausea with or without vomiting - Papilledema - Seizures
Correct response: - Seizures - Nausea with or without vomiting - Papilledema - Headache Explanation: Symptoms of increased intracranial pressure include headache, nausea with or without vomiting, and papilledema. Angina is not associated with increased ICP.
What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply. - Take phenothiazine prior to meals - Increase high carbohydrate foods - Maintain a pureed diet - Use Relaxation techniques - Eliminate foods high in fat
Correct response: - Use Relaxation techniques - Take phenothiazine prior to meals Explanation: Talking to the client before meals will help to promote relaxation, and phenothiazines help to calm some clients. Eliminating foods high in fat, increasing carbohydrates, and pureeing food will not assist in relaxing muscles during choreiform movements. The nurse should wait for the client to chew and swallow, which can be a slow process.
Extensive diagnostic testing has resulted in a patient's diagnosis of a benign brain tumor. When providing care for this patient, the nurse should be cognizant of which of the following characteristics of benign brain tumors? - Benign brain tumors have no physiological effect but should be closely monitored. - Benign brain tumors can slowly grow into an area of vital brain function. - Benign brain tumors constitute a risk factor for possible metastasis. - Benign brain tumors typically become malignant within 1 to 2 years.
Correct response: Benign brain tumors can slowly grow into an area of vital brain function. Explanation: Benign tumors are slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. They do not necessarily develop to malignancy, and they are not primarily understood as simply a risk factor for further cancer.
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? - Liaising with community agencies to organize long-term rehabilitation - Choosing psychosocial interventions that are relevant to the patient's poor prognosis - Teaching the patient about the importance of healthy lifestyle in recovery from GBM - Teaching the patient about the pharmacological interventions relevant to his treatment
Correct response: Choosing psychosocial interventions that are relevant to the patient's poor prognosis Explanation: GBM is the most common and aggressive malignant brain tumor, and the overall prognosis is poor. Consequently, interventions should be chosen in light of this difficult reality. Pharmacological interventions are not the central treatments of GBM.
A patient diagnosed with a pituitary adenoma has arrived on the oncology unit. Based upon the nurse's initial assessment, the patient is most likely to exhibit: - Headache - Decreased level of consciousness - Decreased intracranial pressure (ICP) - Restlessness
Correct response: Headache Explanation: 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 these tumors would not usually cause decreased LOC.
A patient, diagnosed with cancer of the lung, has just been told that she has metastases to the brain. The family should be aware that the neurologic signs and symptoms of metastatic brain disease are most often what? - Bradycardia - Increase in diastolic blood pressure - Temperature greater than 100.5°F - Personality changes
Correct response: Personality changes Explanation: 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 typical neurologic signs and symptoms of metastatic brain disease.
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? - Meningioma - Pituitary adenoma - Glioma - Acoustic neuroma
Correct response: Pituitary adenoma Explanation: 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.
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? - The patient will require weekly, rather than daily, drug administration. - The drug will bypass the blood-brain barrier. - The patient will not require IV access. - The drug can be administered on an outpatient basis.
Correct response: The drug will bypass the blood-brain barrier. Explanation: Chemotherapy that is given by intrathecal injection bypasses the blood-brain barrier. The rationale for choosing this route does not involve foregoing IV access, less frequent administration, or the possibility of outpatient administration.
A patient has been admitted to the neurological ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. What is a priority part of the nurse's preoperative assessment of this patient? - Ability to chew - Sensory perception - The gag reflex - Corneal reflex
Correct response: The gag reflex Explanation: 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 is more important than the gag reflex.
A patient with a suspected brain tumor has been scheduled for a positron emission tomography (PET) scan. The nurse should explain to the patient that this test is being performed to assess: - The metabolic activity taking place in the patient's brain - The tissue characteristics of the patient's brain - The distribution patterns of cerebrospinal fluid (CSF) in the patient's central nervous system - The blood flow in the patient's brain
Correct response: The metabolic activity taking place in the patient's brain Explanation: PET, which measures the brain's activity rather than simply its structure, is useful in differentiating tumor from scar tissue or radiation necrosis. PET is not primarily used to assess blood flow, CSF flow, or structural characteristics.
11) ** The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors? - They are all metastatic. - The prognosis is very poor. - They can affect vital functioning. - They do not require surgical removal.
Correct response: They can affect vital functioning. Explanation: Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.
A client is diagnosed with a tumor of the temporal lobe. When developing the client's plan of care the nurse would plan interventions to address problems with which areas of functioning? Select all that apply. - Writing - Understanding language - Emotions - Reading - Memory
Correct response: Understanding language Emotions Memory Explanation: Tumors of the temporal lobe may cause problems with language comprehension, behavior, memory, hearing and emotion. Problems with reading and writing would be associated with a tumor of the parietal lobe.
A middle-aged patient has undergone emergency neurosurgery for the treatment of spinal cord compression (SCC) that was detected by magnetic resonance imaging (MRI). Which of the following signs and symptoms is considered an early sign of spinal compression? - Intermittent claudication - Urinary incontinence - Personality changes - Muscle spasticity
Correct response: Urinary incontinence Explanation: Early symptoms associated with SCC include back pain, and bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation). Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Personality changes and intermittent claudication are not associated with SCC.
A female patient is admitted for evaluation of a cerebral metastasis from a primary site. When reviewing her history, what would be the MOST likely primary site? A) Lung B) Prostate C) renal D) Uterus
LUNG
