Chapter 44: Nursing Management: Patients With Oncologic Disorders of the Brain and Spinal Cord

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

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

An acoustic neuroma is a benign tumor of which cranial nerve? A. Seventh B. Eighth C. Ninth D. Fifth

B. Eighth An acoustic neuroma is a benign tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance.

A client with a history of a brain tumor is undergoing diagnostic testing to evaluate whether current symptoms are the result of the tumor or scar tissue. The nurse would prepare the client for which test? A. Magnetic resonance imaging (MRI) B. Three-dimensional biopsy C. Cerebral angiography D. Positron emission tomography (PET)

D. Positron emission tomography (PET) PET, which measures the brain's activity rather than simply its structure, is useful in differentiating tumor from scar tissue or radiation necrosis. Computer-assisted stereotactic (three-dimensional) biopsy is being used to diagnose deep-seated brain tumors. Cerebral angiography provides visualization of cerebral blood vessels and can localize most cerebral tumors. MRI is the gold standard for detecting brain tumors (particularly smaller lesions) and tumors in the brainstem and pituitary regions, where bone is thick.

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 psychomotor seizures B. Related to visual field deficits C. Related to difficulty swallowing D. Related to impaired balance

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

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? A. "Surgical resection of the tumor will decrease intracranial pressure." B. "Removing bulk from the tumor will reverse the paralysis." C. "Using this procedure will eliminate the need for chemotherapy." D. "Every life-saving treatment is administered when treating brain tumors."

A. "Surgical resection of the tumor will decrease intracranial pressure." For clients with malignant glioma, complete removal of the tumor and cure are not possible, but the rationale for resection includes relief of intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theoretically leaves behind fewer cells to become resistant to radiation or chemotherapy. Due to the poor prognosis with this tumor, it is not likely that the surgical resection is considered a life-saving measure. Rather the surgical intervention is a means to manage symptoms in the palliative phase of the client's disease. Surgical resection does not eliminate the need for chemotherapy. Due to the malignant nature of this tumor, the surgery will not completely eliminate the tumor, but chemotherapy can be administered to eradicate or slow further cell growth to promote comfort in the palliative phase of the disease. In the case of this client, reversal of paralysis caused by brain tumor compression 6 months ago is not possible. This would not be the aim of the surgical resection.

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? A. Benign brain tumors can slowly grow into an area of vital brain function. B. Benign brain tumors constitute a risk factor for possible metastasis. C. Benign brain tumors typically become malignant within 1 to 2 years. D. Benign brain tumors have no physiological effect but should be closely monitored.

A. Benign brain tumors can slowly grow into an area of vital brain function. 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.

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 sudden 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? A. Magnetic resonance imaging (MRI) B. Computed tomography (CT) C. Positron emission tomography (PET) D. Cranial x-ray

A. Magnetic resonance imaging (MRI) MRI is the gold standard for detecting brain tumors. If a brain tumor is suspected, the MRI will provide a high degree of certainty for ruling out or confirming this diagnosis. Although CT scanning is also used in the diagnostic workup of brain tumors, this test would be prescribed to provide additional diagnostic information about the tumor. A CT scan can give specific information concerning the number, size, and density of the lesions and the extent of secondary cerebral edema. CT can also provide information about the ventricular system (the communicating network of cavities filled with cerebrospinal fluid and located within the brain parenchyma). PET, which measures the brain's activity rather than simply its structure, is useful in differentiating tumor from scar tissue or radiation necrosis. The PET may be useful during or after completion of treatment to determine the progress of the tumor. A cranial x-ray would not provide detailed imaging of the brain and would be best suited to determine any pathology related to the bone surface of the cranium. A cranial fracture could be detected using the x-ray but not a brain tumor.

A client is suspected of having a spinal cord tumor. What diagnostic study would the nurse include in the client teaching? A. Magnetic resonance imaging scan B. Positron emission tomography scan C. Chest radiology D. Complete blood count

A. Magnetic resonance imaging scan The magnetic resonance imaging scan is the most commonly used and the most sensitive diagnostic tool for spinal cord tumors. A positron emission tomography scan helps determine how organs and tissues are working. A chest radiology study is used to examine structures in the chest. A complete blood count will not aid in diagnosis of a spinal cord tumor.

A client is about to be discharged after undergoing surgery for the treatment of a brain tumor and has a referral in place for medical and radiation oncology. Which component(s) should be included in the discharge teaching for this client? Select all that apply. A. Nutritional support B. Electromyography C. Adverse effects of chemotherapy or radiation and techniques for managing them D. Appointments for chemotherapy or radiotherapy E. Medication regimen

A. Nutritional support C. Adverse effects of chemotherapy or radiation and techniques for managing them D. Appointments for chemotherapy or radiotherapy E. Medication regimen The nurse should include the medication regimen, appointments for chemotherapy and radiotherapy, adverse effects of chemotherapy or radiation and techniques for managing them, and nutritional support as components of the discharge teaching for this client. Electromyography is used in amyotrophic lateral sclerosis (ALS) to validate weakness in the affected muscles and should not be included for the client being discharged after surgery for a brain tumor.

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. Pituitary adenoma B. Acoustic neuroma C. Glioma D. Meningioma

A. Pituitary adenoma 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.

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? A. They can affect vital functioning. B. They do not require surgical removal. C. The prognosis is very poor. D. They are all metastatic.

A. They can affect vital functioning. Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.

The nurse is 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? A. "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." B. "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." C. "I am assuming your provider was trying to explain to you that meningiomas have a high cure rate if treated with surgery, chemotherapy and radiation aggressively." D. "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."

B. "I am unable to interpret what your provider meant by making that statement; however, it is true that meningiomas are slow growing tumors that are not typically fatal." The nurse should inform the client that nurses cannot interpret what another provider meant by the statement. The nurse can provide client education regarding what is known about the type of brain tumor the client has been diagnosed with. It would be incorrect for the nurse to state that the treatment for this type of brain tumor is aggressive. The tumor is slow growing. and sometime treatment is a 'wait-and-see' approach. Thus, surgery, chemotherapy and radiation would not typically be used together or aggressively. By telling the client the provider was trying to be supportive with the statement that was made communicates to the client that the provider was not telling the truth about the nature of the diagnosis. In this case, the nurse is making an assumption and should not try to interpret for the client what the provider said. It would be countertherapeutic and serve to increase the client's anxiety if the nurse stated discussing the details of the client's diagnosis is not within the nurse's scope. The nurse can provide information about the type of brain tumor within the scope of practice.

A 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? A. Intracerebral hemorrhage B. Compression of brain tissue C. Impaired cerebrospinal fluid (CSF) synthesis D. Invasion of brain tissue by the tumor

B. Compression of brain tissue Manifestations of meningiomas depend on the area involved and are the result of compression rather than invasion of brain tissue. These tumors do not normally result in alterations in CSF production or bleeding.

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? A. Hearing loss B. Hemorrhagic stroke C. Thyroid disorders D. Visual loss

B. Hemorrhagic stroke Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.

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 supine with call bell in close reach B. Position client side lying with head of bed elevated to 30 degrees C. Position client in Trendelenburg with legs raised 15 degrees D. Position client with head of bed elevated to 45 degrees

B. Position client side lying with head of bed elevated to 30 degrees The client with a brain tumor may be at increased risk for aspiration due to cranial nerve dysfunction. If the client is at risk for aspiration, he or she should be placed in a side-lying position due to decreased level of consciousness and with the head of the bed elevated 10 to 30 degrees to promote passive drainage of fluids. Placing the client in a supine position increases the risk for aspiration. Elevating the head of the bed 45 degrees is too high and can also increase the risk for aspiration. Trendelenburg position indicates the client has been placed supine with the legs elevated. This is unsafe for a client with the risk for aspiration, because this position can increase the client's risk.

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? A. Infection at the surgical site B. Growth of a secondary tumor C. Impaired tissue healing D. Cerebrospinal fluid leakage

D. Cerebrospinal fluid leakage Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF.

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

D. Huntington disease Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with Huntington disease has a 50% risk of inheriting the illness. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Parkinson disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

In which location are most brain angiomas located? A. Cerebellum B. Thalamus C. Hypothalamus D. Brainstem

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

B. 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.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to A. identify the precise location of the tumor. B. prevent extension of the tumor. C. reduce cerebral edema. D. facilitate regeneration of neurons.

C. reduce cerebral edema. Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.

An older client complains of a constant headache. A physical examination shows papilledema. What may the symptoms indicate in this client? A. Hypostatic pneumonia B. Trigeminal neuralgia C. Epilepsy D. Brain tumor

D. Brain tumor The incidence of brain tumor increases with age. Headache and papilledema are less common symptoms of a brain tumor in the older adult. Symptoms of epilepsy include fits and spasms, while symptoms of trigeminal neuralgia would be pain in the jaws or facial muscles. Hypostatic pneumonia develops due to immobility or prolonged bed rest in older clients.

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? A. Coumadin B. Decadron C. Paclitaxel D. Dilantin

A. Coumadin' Although deep vein thrombosis and pulmonary embolism occur in about 15% of patients and cause significant morbidity, anticoagulants are not prescribed due to the risk for CNS hemorrhage.

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

A. Cushing disease can result from a functioning tumor. Endocrine disorders can result from the existence of functioning pituitary adenomas. These tumors cause the production of hormones at the anterior pituitary and there may be an increase in various hormones, including cortisol that is responsible for the development of Cushing disease. Pituitary adenomas are rarely seen in the pediatric population. Most pituitary adenomas are benign tumors. The incidence of pituitary adenoma tumors is higher in women than men.

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

C. Chorea The most prominent clinical features of Huntington disease include chorea, intellectual decline, and often emotional disturbance. As the disease progresses, speech becomes slurred, gait becomes disorganized, and cognitive function is altered with dementia.

A nurse is reviewing a client's medical record and finds that the client has a spinal cord tumor that involves the vertebral bodies. The nurse identifies this as which type of spinal tumor? A. Intradural-extramedullary B. Metastatic C. Extradural D. Intramedullary

C. Extradural Tumors within the spine are classified according to their anatomic relation to the spinal cord. Intramedullary tumors arise from within the spinal cord. Intradural-extramedullary tumors are within or under the spinal dura but not on the actual spinal cord. Extradural tumors are located outside the dura and often involve the vertebral bodies.

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

C. low bone mass and osteoporosis. 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.

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

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

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

D. 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 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: A. The blood flow in the patient's brain B. The distribution patterns of cerebrospinal fluid (CSF) in the patient's central nervous system C. The tissue characteristics of the patient's brain D. The metabolic activity taking place in the patient's brain

D. The metabolic activity taking place in the patient's brain 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.

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 effective treatment. C. Surgery can improve survival time but the results are not guaranteed. D. Radiation is not an option because of the tumor's location near the brainstem.

C. Surgery can improve survival time but the results are not guaranteed. The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time.

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. Ependymoma B. Meningioma C. Astrocytoma D. Medulloblastoma E. Acoustic neuroma

A. Ependymoma C. Astrocytoma D. Medulloblastoma Glial tumors, the most common type of intracerebral brain neoplasm, are divided into many categories, including astrocytomas, ependymomas, and medulloblastomas. Meningiomas occur on the meninges and acoustic neuromas on the eight cranial nerve, and thus are not intracerebral tumors.

The nurse is seeing a client who is being investigated for a possible spinal tumor. The nurse knows that a tumor in this region of the body is more likely if the client reports increased pain when: A. sleeping on the stomach. B. standing. C. lying on the side. D. lying flat on the back.

A. sleeping on the stomach. When assessing a client for whom there is suspicion of a spinal tumor, the nurse is alert for early reports of back pain, which occurs in the region of the tumor. The pain typically increases when the client is in the prone position. When lying flat on the stomach, the client is in a prone position. The client is more likely to report pain when in this position. Although pain may be present in other body positions, pain in the prone position can be a cardinal sign.

The nurse educator is providing information to a group of nurses regarding different types of brain tumors. The nurse is correct in explaining that total surgical resection of a glioblastoma multiforme (GBM) is not possible for which reason? A. There is a capsule surrounding the tumor. B. The presence of finger-like tentacles produced by the tumor. C. The tumor covers the meninges of the brain. D. The tumor is surrounded by blood vessels.

B. The presence of finger-like tentacles produced by the tumor. Total surgical resection of GBM is difficult due to the "finger-like tentacles" the tumor produces. The goal of surgery is to remove as much tumor as possible without causing any neurologic damage. Despite treatment, median life expectancy is 14.6 months. Meningiomas are characterized as benign, encapsulated, slow-growing tumors. Brain angiomas are masses composed largely of abnormal blood vessels are found either in the brain or on its surface. Meningiomas are tumors that grow on the membrane covering of the brain, called the meninges.

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

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

Which of the following are clinical manifestations associated with increased intracranial pressure (ICP)? Select all that apply. A. Nausea with or without vomiting B. Papilledema C. Headache D. Angina E. Seizures

A. Nausea with or without vomiting B. Papilledema C. Headache E. Seizures Symptoms of increased intracranial pressure include headache, nausea with or without vomiting, and papilledema. Angina is not associated with increased ICP.

A client diagnosed with a brain tumor is exhibiting focal symptoms. Which assessment findings are the nurse likely to note? Select all that apply. A. Visual changes B. Aphasia C. Vomiting D. Muscle weakness E. Sensory loss

A. Visual changes B. Aphasia D. Muscle weakness E. Sensory loss Common focal, or localized, symptoms include muscle weakness, sensory loss, aphasia, and visual changes. When specific regions of the brain are affected, additional local signs and symptoms occur, such as motor abnormalities, changes in hearing, alterations in cognition, and language disturbances. Vomiting would be considered a generalized symptom.

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

B. 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.

Which medication classification should be avoided in the treatment of brain tumors? A. Corticosteroids B. Anticonvulsants C. Anticoagulants D. Osmotic diuretics

C. Anticoagulants Anticoagulants usually are not prescribed because of the risk for central nervous system (CNS) hemorrhage; however, prophylactic therapy with low-molecular-weight heparin is under investigation. Osmotic diuretics, corticosteroids, and anticonvulsants are utilized in the treatment of brain tumors.

A client with a malignant brain tumor comes to the clinic for a follow up. During the visit, the client asks the nurse, "Why am I so tired all the time?" When responding to the client, which information would the nurse include as possible causes? Select all that apply. A. Effects of increased intracranial pressure B. Treatment being used C. Metastasis D. Stress E. Tumor

B. Treatment being used D. Stress E. Tumor Fatigue is a symptom experienced by clients with both malignant and nonmalignant brain tumors. Etiology of fatigue can be multifactorial. The tumor itself, surgery, medications, chemotherapy, and radiation may all contribute to increased fatigue. Clients may report a constant feeling of exhaustion, weakness, and lack of energy. It is also important to identify underlying conditions, such as stress, anxiety, and depression, which may play a role in fatigue. Metastasis and increased intracranial pressure are not usually associated with fatigue.

A client is scheduled for diagnostic testing to evaluate the possibility of a brain tumor. The nurse would anticipate preparing the client for which test? A. Lumbar puncture B. computed tomography (CT) scan C. magnetic resonance imaging (MRI) D. Electroencephalography

C. magnetic resonance imaging (MRI) Although other diagnostic tests may be done to assist in evaluating a brain tumor, MRI is the gold standard for detecting brain tumors.

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? A. Low bone mass and osteoporosis B. Osteoarthritis C. Pathologic fractures D. Calcification of long bones

A. Low bone mass and osteoporosis 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 term is used to describe edema of the optic nerve? A. Lymphedema B. Scotoma C. Papilledema D. Angioneurotic edema

C. 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.

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? A. Computed tomography (CT) B. MRI C. Positron-emission tomography (PET) D. Computer-assisted stereotactic biopsy

C. Positron-emission tomography (PET) A PET scan is most diagnostic for brain activity, as well as for assessment of tumor size. It can also be useful in differentiating a tumor from scar tissue or radiation necrosis.

A 37-year-old male is brought to the clinic by his wife because the patient is experiencing loss of motor function and sensation. After initial neurological assessment, the health care provider 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 diagnosis spinal cord compression from a tumor is what? A. A magnetic resonance imaging (MRI) scan B. A computed tomography (CT) scan C. An ultrasound D. An X-ray

A. A magnetic resonance imaging (MRI) scan 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.

The nurse is planning the care of a patient who has been admitted to the hospital for surgical treatment of prostate cancer that has metastasized to his spine. When planning nursing care that is specific to this patient's spinal metastasis, what outcome should the nurse identify? A. The patient will maintain full range of motion. B. The patient will explain the importance of exercise in his recovery. C. The patient will state that pain control is adequate. D. The patient will perform activities of daily living comparable to his prediagnosis abilities.

C. The patient will state that pain control is adequate. Severe pain is associated with spinal metastases and should be prioritized during nursing care. Mobility is not a short-term priority with this patient's diagnoses, and it is unrealistic to expect prediagnosis levels of function.

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. A. Memory B. Emotions C. Reading D. Understanding language E. Writing

A. Memory B. Emotions D. Understanding language 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.

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

B. Magnetic resonance imaging (MRI) MRI is the most commonly used diagnostic tool, detecting epidural spinal cord compression and metastases.

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. Bowel incontinence B. Hemorrhage C. Respiratory dysfunction D. Skin breakdown

C. 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.

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. A. Abnormal eye movements B. Visual hallucinations C. Muscle incoordination D. Apathetic mental attitude E. Staggering gait

A. Abnormal eye movements C. Muscle incoordination E. Staggering gait 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 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? A. The patient will not require IV access. B. The drug will bypass the blood-brain barrier. C. The drug can be administered on an outpatient basis. D. The patient will require weekly, rather than daily, drug administration.

B. The drug will bypass the blood-brain barrier. 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 client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. What is the supportive goal for the client diagnosed with muscular dystrophy? A. Client will be free of respiratory complications. B. Client will complete end-of-life decisions. C. Genetic testing will identify specific gene mutations. D. Minimized functional deterioration in the client.

D. Minimized functional deterioration in the client. The goal of supportive management is to keep the client active and functioning as normally as possible and to minimize functional deterioration. Client will have respiratory complications at times, but this is not the target of the supportive goal. Gene mutations are useful, but not a generalized goal for clients. Clients with muscular dystrophy should make end-of-life decisions, but this is not the client's supportive goal.

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? A. Surgery B. Radiation therapy C. Chemotherapy D. Immunotherapy

A. 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.

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? A. Computed tomography B. Ultrasonography C. Magnetic resonance imaging D. Core needle biopsy

C. 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.

What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply. A. Eliminate foods high in fat B. Maintain a pureed diet C. Take phenothiazine prior to meals D. Increase high carbohydrate foods E. Use Relaxation techniques

C. Take phenothiazine prior to meals E. Use Relaxation techniques 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.

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? A. Choosing psychosocial interventions that are relevant to the patient's poor prognosis B. Liaising with community agencies to organize long-term rehabilitation C. Teaching the patient about the pharmacological interventions relevant to his treatment D. Teaching the patient about the importance of healthy lifestyle in recovery from GBM

A. Choosing psychosocial interventions that are relevant to the patient's poor prognosis 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.

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? A. Meningiomas B. Pituitary adenomas C. Gliomas D. Acoustic neuromas

C. Gliomas Gliomas are the most common type of intracerebral brain tumor. Meningiomas account for approximately 15% of all primary brain tumors. Pituitary adenomas represent approximately 10% to 15% of all brain tumors. Acoustic neuromas are less common.

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? A. The gag reflex B. Ability to chew C. Sensory perception D. Corneal reflex

A. The gag reflex 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 client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? A. "You must lie flat for 24 hours after surgery." B. "You must avoid coughing, sneezing, and blowing your nose." C. "You must report ringing in your ears immediately." D. "You must restrict your fluid intake."

B. "You must avoid coughing, sneezing, and blowing your nose." After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

The nurse is caring for a client with metastatic brain cancer. The client will be receiving palliative treatment. The nurse should anticipate what type of medical management will be included in the client's care? Select all that apply. A. Computer-assisted stereotactic biopsy B. Radiation C. Positron emission tomography (PET) D. Radiosurgery E.. Craniotomy with debulking

B. Radiation D. Radiosurgery E.. Craniotomy with debulking When the prognosis for any brain tumor is poor, the palliative care approach is used to guide the management of symptoms with the aim of increasing client comfort and decreasing distressing symptoms as much as possible. This can include surgical debulking of the tumor, which requires a craniotomy. Treatment using radiosurgery provides a very high dose of radiation to a very small precise area to decrease tumor size to prevent a rise in intracranial pressure. These treatment techniques are known as Gamma Knife or Cyberknife. Simple radiation is also used to decrease the size of the tumor in a less invasive way than surgery. The aim of this treatment is also to increase comfort and prolong life by decreasing pressure on surrounding brain structures and intracranial pressure. The alternate answer options list diagnostic techniques that would only be used when imaging of the tumor is required for diagnosis to plan treatment.

The nurse is providing education to a client diagnosed with a brain tumor who has been prescribed dexamethasone as part of the treatment. The nurse should include what information about the potential side effects of this medication? A. Hypoglycemia B. Increased sleepiness C. Irritability D. Anorexia

C. Irritability One of the common side effects of dexamethasone is irritability, and the nurse should provide education about possible mood changes that may occur as a result of the irritability. With this medication, there is the risk for hyperglycemia (a rise of blood glucose levels), not hypoglycemia. The client should be informed to expect a possible increase in appetite, not anorexia. Insomnia or difficulty sleeping, not increased sleepiness, is also a known common side effect of this medication.

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

D. Increased prolactin levels A characteristic of functioning pituitary tumors is the overproduction of prolactin, which can lead to irregular or diminished menstrual periods in women. Functioning pituitary tumors lead to an increase in the production of several hormones including growth hormone and adrenocorticotropic hormone, not a decrease. Nonetheless, the client would not experience changes in her menstrual periods as a result of increases in these two hormones. Although functioning pituitary tumors can cause an increase in thyroid-stimulating hormone, this would not be the cause of changes in the client's normal menstrual periods.

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? A. Temozolomide B. Mannitol C. Everolimus D. Bevacizumab

B. Mannitol Mannitol is an osmotic diuretic that is administered to decrease the fluid content of the brain, which leads to a decrease in intracranial pressure. Temozolomide is a chemotherapeutic agent which is commonly used to stop or slow cell growth in certain types of brain tumors. Bevacizumab and everolimus are immunotherapy agents that reduce the vascularization of tumors, thereby inhibiting tumor growth.

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? A. Subarachnoid space B. Central vein C. Implanted port D. Epidural space

A. Subarachnoid space Chemotherapy given intrathecally is injected directly into the subarachnoid space, not a central vein, implanted port or epidural space.

Corticosteroids are used in the treatment of brain tumors for which of the following clinical manifestations? Select all that apply. A. Seizures B. Cerebral edema C. Personality changes D. Headache E. Altered level of consciousness

B. Cerebral edema D. Headache E. Altered level of consciousness Corticosteroids are used during treatment to reduce cerebral edema and reduce side effects of treatment, such as nausea and vomiting. They are also helpful in relieving headache and alterations in level of consciousness. Antiseizure agents are used to treat seizures if they occur. Corticosteroids are not used for personality changes associated with brain tumors.

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. A. If a dose is missed, the client should take double the amount at the regular time the following day. B. Hair loss should be expected when taking the medication. C. The client should ensure no one else handles the medication. D. The client should seek emergency care if he or she develops a fever. E. The client should seek emergency help if nausea or vomiting occur.

B. Hair loss should be expected when taking the medication. C. The client should ensure no one else handles the medication. D. The client should seek emergency care if he or she develops a fever. The client should be the only person to handle the medication. Because it is a chemotherapy agent, it is cytotoxic and can have a harmful effect on anyone who does not have a tumor. It is unsafe to take a double dose of the medication if it is missed the previous day. The client should be instructed to take the medication at the same time each day and, if a dose is missed, the client should be instructed to take it as soon as possible and then get back on the regular schedule again. Some clients taking this medication experience gastrointestinal side effects such as nausea and vomiting. Although this is not considered an emergency, the client should be instructed to discuss this side effect with the health care provider, because prolonged symptoms can lead to nutritional deficit and/or dehydration. Immunosuppression caused by the medication can lead to a white blood cell count too low to fight off an infection. A fever is a sign of infection and can be life-threatening for a person taking a chemotherapeutic agent. Care should be sought immediately in this case. A common side effect of this medication is alopecia or hair loss. The client should be made aware to anticipate that this is a possibility while taking the drug.

A client being treated for a brain tumor is exhibiting signs and symptoms of cerebral edema. The nurse anticipates that the practitioner will most likely prescribe which agent? A. Anticonvulsant agent B. Corticosteroid C. Diuretic D. Immunotherapy agent

B. Corticosteroid Corticosteroids are used during treatment to reduce cerebral edema and to reduce the side effects of treatment, such as nausea and vomiting. They are also helpful in relieving headache and alterations in level of consciousness. Immunotherapy agents are used to treat spinal cord tumors. Anticonvulsants are used to control seizures. Diuretics would not be used to control cerebral edema in this case.

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

D. Simple to generalized seizures. Seizures are usually the first symptom of a brain tumor.

A nurse is reviewing the medical record of a client diagnosed with a primary brain tumor. The nurse identifies the type of tumor as one that is most commonly found in adults. Which type of tumor would the nurse most likely identify? A. pituitary adenoma B. angioma C. acoustic neuroma D. meningioma

D. meningioma' Although acoustic neuromas, pituitary adenomas and angiomas can occur in adults, meningiomas are the most common type of brain tumor found in adults.

The nursing educator on a neurological unit is conducting a brief in-service on glial cell tumors. The educator tells the nurses 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 is the tumor's grading based on? A. Cellular density, cell mitosis, and appearance B. Size of cells, number of cells, and appearance C. Cellular density, number of cells, and appearance D. Cell mitosis, size of cells, and appearance

A. Cellular density, cell mitosis, and appearance The grading of a glioma is based on cellular density, cell mitosis, and appearance.

What interventions will best help the client with Huntington disease relieve anxiety and increase communication? Select all that apply. A. Consult with a speech therapist. B. Always have family present. C. Use biofeedback. D. Use an interpreter. E. Talk as little as possible.

A. Consult with a speech therapist. C. Use biofeedback. Using biofeedback and relaxation therapy may help to decrease stress and help with communication. A speech therapist can help maintain and prolong communication abilities as well. An interpreter is not needed and the client should be encouraged to talk. Family presence is not essential, but the nurse should learn how the client expresses needs and wants, especially if the client is nonverbal.

What is the most common type of brain neoplasm? A. Glioma B. Meningioma C. Neuroma D. Angioma

A. Glioma Gliomas are the most common brain neoplasms, accounting for about 45% of all brain tumors. Angiomas account for approximately 4% of brain tumors. Meningiomas account for 15% to 20% of all brain tumors. Neuromas account for 7% of all brain tumors.

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

C. Autosomal dominant Huntington disease is transmitted as an autosomal dominant genetic disorder. It is a genetic mutation , caused by the presences of a repeat of the ( Huntington gene) HTT gene. This disease is a chronic, progressive, hereditary disorder of the nervous system and results in progressive involuntary choreiform movements and dementia.

Which of the following is a common cancer that metastasizes to the spinal cord? Select all that apply. A. Brain B. Colon C. Breast D. Lung E. Prostate

C. Breast D. Lung E. Prostate Cancer can spread to the spinal cord. The three most common cancers that metastasize to the spinal cord are breast, prostate, and lung. Cancer can invade the cord, causing vertebral metastases. Colon and brain cancers do not commonly metastasize to the spinal cord.

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

C. Most tumors produce too much of one or more hormones. The majority of these tumors are benign. In rare cases, they may be malignant. Functioning tumors produce hormones, frequently in excessive amounts, resulting in conditions such as hyperthyroidism, Cushing's syndrome, and gigantism or acromegaly.

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

C. Pain Pain is the hallmark of spinal metastases. Nausea, fatigue, and change in LOC may occur, but these are not the hallmark of spinal metastases.

A client is diagnosed with a brain angioma. When providing care to this client, the nurse would be especially vigilant in monitoring for signs and symptoms of which of the following? A. Hydrocephalus B. Seizures C. Infection D. Hemorrhagic stroke

D. Hemorrhagic stroke Although any brain tumor may lead to seizures and hydrocephalus, a client with an angioma is at high risk for hemorrhagic stroke because the walls of the blood vessels in angiomas are thin. Infection is a possibility but would be considered less likely.

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 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 60 kg. Next, set up a proportion: 10/1 = x/60; cross multiply and solve for x, which is 600.

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

B. "Intravenous immunoglobulin infusion may help you." There is no specific treatment for post-polio syndrome; however, the infusion of IV immunoglobulin has been shown to help with the physical pain and weakness. Sleeping and relaxation may not assist the client with post-polio syndrome. The syndrome is very common and is most likely related to the past diagnosis of polio.

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. A. Aphasia B. Double vision C. Swaying gait D. Enhanced visual acuity E. Visual field deficit

B. Double vision E. Visual field deficit 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.

How should the nurse best teach the client admitted with post-polio syndrome about causative pathophysiology? A. Post-polio syndrome is caused by long-term intake of a low-protein, high-fat diet in polio survivors. B. Post-polio syndrome is caused by an autoimmune response. C. The exact cause is unknown, but aging or muscle overuse is suspected. D. The exact cause is unknown, but latent poliovirus is suspected.

C. The exact cause is unknown, but aging or muscle overuse is suspected. The exact cause of post-polio syndrome is not known, but researchers suspect that with aging or muscle overuse, the neurons that were not destroyed originally by the poliovirus are unable to continue generating axon sprouts. The exact cause of post-polio syndrome is not known.

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. An occipital lobe tumor C. A frontal lobe tumor D. A motor cortex tumor

D. A motor cortex tumor A tumor in the motor cortex of the frontal lobe produces hemiparesis and partial seizures on the opposite side of the body or generalized seizures. A frontal lobe tumor may also produce changes in emotional state and behavior, as well as an apathetic mental attitude. 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. An occipital lobe tumor produces visual manifestations: contralateral homonymous hemianopsia (visual loss in half of the visual field on the opposite side of the tumor) and visual hallucinations.

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? A. Meningioma B. Acoustic neuroma C. Pituitary adenoma D. Angioma

D. Angioma Because the walls of the blood vessels in angiomas are thin, affected patients are at risk for hemorrhagic stroke. In fact, cerebral hemorrhage in people younger than 40 years of age should suggest the possibility of an angioma.

A nurse is caring for a client with a pituitary adenoma. Which laboratory test result suggests that a client has a corticotropin-secreting pituitary adenoma? A. High corticotropin and low cortisol levels B. Low corticotropin and high cortisol levels C. Low corticotropin and low cortisol levels D. High corticotropin and high cortisol levels

D. High corticotropin and high cortisol levels Pituitary adenomas secrete excess amounts of hormones, including adrenocortical-tropic hormone, resulting in Cushing syndrome, in which a corticotropin-secreting pituitary tumor causes high corticotropin and high cortisol levels. A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level are associated with hypocortisolism. A primary defect in the adrenal glands causes low corticotropin and high cortisol levels.

A patient's brain tumor has been manifested by seizures that have become more frequent and severe in recent days. The patient has been scheduled for neurosurgery but the nurse is nonetheless making changes to the patient's preoperative nursing care plan. The patient's seizures should cause the nurse to prioritize which of the following nursing diagnoses? A. Impaired memory related to seizure activity B. Acute pain related to seizure activity C. Imbalanced nutrition: less than body requirements related to seizures D. Risk for injury related to seizures

D. Risk for injury related to seizures Seizure activity presents a significant risk of injury that must be proactively addressed in nursing care. Impaired memory may accompany seizures, but safety is a priority over this consideration or temporary nutritional deficits. Seizures do not normally cause pain.

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. A. Ensure that the client is free of pain for meals. B. Place the client near the sounds and smells of meals being prepared. C. Plan meals for times when the client is rested. D. Prepare the client for the insertion of a feeding tube. E. Provide the client with foods that he likes.

A. Ensure that the client is free of pain for meals. C. Plan meals for times when the client is rested. E. Provide the client with foods that he likes. Suggestions to improve nutrition include making sure that the client is comfortable, free of pain, and rested. This may require family members to adjust meal times. Additionally, they should eliminate offensive sights, sounds, and odors. Therefore, placing the client near sites of meal preparation may be too overwhelming. If the client has difficulty with or shows disinterest in usual foods, the family should offer foods that the client prefers, rather than attempting to get the client to eat as previously. If the client shows marked deterioration, then some other form of nutritional support such as a feeding tube or parenteral nutrition may be indicated, but only if this measure is consistent with the client's choices for care.

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

A. Tell the family member to get the client to hospital for emergency assessment The client's reported symptoms are indicative of spinal cord compression, a complication of spinal cord tumors that can lead to permanent paralysis and several other irreversible sensory impairments. Signs and symptoms of spinal cord compression warrant an urgent assessment, because it is an emergency. Providing education regarding pain management, sharing information about expected symptoms and encouraging the client to lie in the prone position are all ineffective and unsafe nursing actions, because the presenting complaints warrant emergency assessment and intervention.

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

C. Client participates in activities of daily living using adaptive devices. The muscular dystrophies are a group of incurable muscle disorders characterized by progressive weakening and wasting of the skeletal or voluntary muscles. Nursing care focuses on maintaining the client at his or her optimal level of functioning and enhancing the quality of life. Therefore, the outcome of participating in activities of daily living with adaptive devices would be most appropriate. Medications are not used to treat these disorders; however, they may be necessary if the client develops a complication such as respiratory dysfunction. The disorder is incurable and progressive, not chronic. Diagnostic follow-up would provide little if any information about the course of the disorder.

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. Laryngeal carcinoma C. Pituitary carcinoma D. Colorectal carcinoma

C. Pituitary carcinoma Pituitary carcinoma most commonly arises in the anterior pituitary (adenohypophysis) and must be removed by way of a transsphenoidal approach, using a bivalve speculum and rongeur. Surgery to treat esophageal carcinoma usually is palliative and involves esophagogastrectomy with jejunostomy. Laryngeal carcinoma may necessitate a laryngectomy. To treat colorectal cancer, the surgeon removes the tumor and any adjacent tissues and lymph nodes that contain cancer cells.

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: A. Headache B. Decreased level of consciousness C. Restlessness D. Decreased intracranial pressure (ICP)

A. Headache 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 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. Migraines B. Dehydration C. Increased intracranial pressure D. The tumor is shrinking.

C. Increased intracranial pressure Headache, although not always present, is most common in the early morning and is made worse by coughing, straining, or sudden movement. It is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor, leading to increased intracranial pressure.

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. A. Beck Depression Inventory (BDI) B. Chest auscultation C. Glasgow coma scale (GCS) D. Urinalysis E. Mini mental status examination (MMSE)

C. Glasgow coma scale (GCS) E. Mini mental status examination (MMSE) Included within the neurological examination to determine deficits, the nurse should use the GCS, an assessment tool that can help identify the severity of brain injury for clients who have had surgery to remove a brain tumor. The MMSE can assist in evaluating the client's orientation to person, place and time. This tool can also assist the nurse is identifying changes to the client's cognitive functioning that may result from brain injury. A urinalysis would not provide any information on the client's neurological status. This test can provide information about the appearance, concentration and content of urine, but this is non-specific to issues related to neurological status. Chest auscultation is useful when conducting a respiratory assessment. The BDI is used to quantify an assessment of a client's mood and the severity of depression. This tool can be helpful when screening for mood disorders, but it does not provide any useful information about neurological status.

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? A. Brain biopsy B. Computed tomography (CT) scan C. Magnetic resonance imaging (MRI) D. Blood work with adrenocorticotropic hormone (ACTH) levels

C. Magnetic resonance imaging (MRI) 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 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? A. Intermittent claudication B. Personality changes C. Muscle spasticity D. Urinary incontinence

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

B. "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.

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. Originated within the brain tissue. C. Developed on the cranial nerves. D. Originated from the coverings of the brain.

B. Originated within the brain tissue. The most aggressive type of malignant brain tumor is a glioma, which originates within the brain tissue.

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? A. Prolactin B. Adrenocorticotropic hormone C. Growth hormone D. Thyroid-stimulating hormone

D. Thyroid-stimulating hormone In clients diagnosed with pituitary tumors, increase may be seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone. In this case, the client is exhibiting symptoms related to hyperthyroidism and the blood work should include the thyroid-stimulating hormone level to determine if an overproduction of this hormone due to the presence of the tumor is the cause of the presenting symptoms.

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? A. BP = 90/50 mm Hg; HR = 75 bpm B. BP =130/80 mm Hg; HR = 55 bpm C. BP = 175/45 mm Hg; HR = 42 bpm D. BP = 150/90 mm Hg; HR = 90 bpm

C. BP = 175/45 mm Hg; HR = 42 bpm With a blood pressure of 175/45 mm Hg, it is evident that this client is experiencing progressively rising ICP, resulting from an advanced stage of the brain tumor. This blood pressure demonstrates a wide pulse pressure, meaning the difference between systolic and diastolic pressure is large. A heart rate of 42 bpm indicates the client is bradycardic. This finding paired with hypertensive blood pressure with a widening pulse pressure are part of the Cushing triad related to increased ICP.

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? A. Audible bruit over the skull B. An increase in prolactin C. Tissue biopsy D. Weber and Rinne test

C. Tissue biopsy Glioblastoma multiforme is the most common and aggressive malignant brain tumor. In most cases, a tissue biopsy, which can be obtained at the time of surgical removal, is needed to confirm the diagnosis. A Weber and Rinne test may be useful in assessing asymmetric hearing loss associated with an acoustic neuroma, not glioblastoma multiforme. The diagnosis of an angioma is suggested by the presence of another angioma somewhere in the head or by a bruit (an abnormal sound) that is audible over the skull. Functioning pituitary adenoma can produce one or more hormones, normally by the anterior pituitary. Increase maybe seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone.

While reviewing the nursing documentation on a patient on the neurological unit, the nurse notes that the patient complained of a headache several times over the previous shift. How can the nurse differentiate between a headache that is caused by a brain tumor and a headache that is caused by meningitis or encephalitis? A. Assess the patient's carotid pulses bilaterally. B. Assess the active and passive range of motion of the patient's neck. C. Assess for the presence of a fever. D. Assess the patient's orientation to person, place, and time.

C. Assess for the presence of a fever. When the patient complains of a headache, the nurse assesses the patient's temperature. The nurse knows that fever with headache is associated with an infectious process such as meningitis or encephalitis, whereas headache without fever is associated with a tumor or intracerebral bleeding.

The nurse determines which nursing intervention would best assist the client with a brain tumor who may be at increased risk for aspiration? A. Frequent reorientation B. Assistance with self-care C. Monitoring vital signs D. Evaluation of gag reflex and ability to swallow

D. Evaluation of gag reflex and ability to swallow Evaluation of the gag reflex and ability to swallow to prevent the risk of aspiration is an important nursing intervention. Monitoring vital signs, assistance with self-care, and frequent reorientation are important, but are not the most important intervention.

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? A. Unusual sensitivity to heat and cold B. Visual disturbances C. Disruption in sleep patterns D. Increased intracranial pressure

D. Increased intracranial pressure All the choices are signs and symptoms that can occur with an adenoma, depending on whether the pressure is exerted on the hypothalamus, the third ventricle, or the optic nerves, chiasm, or tracts. Increased intracranial pressure occurs when the third ventricle is affected.

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? A. Elimination of distressing signs and symptoms B. Improved quality of life C. Removal of all or part of the tumor D. Reduced incidence of recurrence

B. 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.

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? A. "If a corticosteroid has been prescribed, do not take it at the same time as this medication." B. "If the previous day's dose was forgotten, take two at the regular time the next day." C. "Driving a car should be avoided until the you know how this medication effects you." D. "Suicidal ideation is a common side effect of this medication and should be reported immediately."

C. "Driving a car should be avoided until the you know how this medication effects you." The nurse should caution the client against driving until the client has a good understanding of how the medication affects his or her central nervous system. For some individuals, the degree of somnolence is much greater than for others and, in some cases, the somnolence is higher when the medication is first initiated and then begins to lesson with physiological adaptation. If a dose is forgotten, the client should be told to take the same dose as soon as he or she remembers. If the time is too close to the following day's dose, the client should be instructed to omit the previous day's dose and just take the current day's dose only. The client should never double up on the dose. There are no cautionary concerns about taking the medication at the same time as a glucocorticoid. There are no established drug-drug interactions between these two type of medications. Suicidal ideation is a rare side effect of levetiracetam. Although the nurse can provide education to the client about this rare side effect, the nurse must indicate this is not a common finding with this medication.

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

C. "Grade 1 is the most common type of this tumor." Grade I meningiomas are the most common of meningioma and can be cured by surgery. Grades II and III are less common and grow quickly. They can spread to the brain and spinal cord. These tumors have a poorer prognosis and usually cannot be completely resected. Despite this information, the nurse should not be making statements about prognosis as this is not within the nurse's scope. Manifestations depend on the area involved and are the result of compression rather than invasion of brain tissue.

A client who has a pituitary adenoma would report which symptoms related to the presence of this type of tumor? Select all that apply. A. Morning headaches B. Polydipsia C. Anorexia D. Chiasmal syndrome E. Fever

A. Morning headaches B. Polydipsia C. Anorexia D. Chiasmal syndrome Common symptoms reported in association with the diagnosis of a pituitary adenoma include headaches in the morning, and changes in the visual field resulting from pressure on the optic nerves, optic chiasm and optic tracts. It is the pressure on the optic chiasm that can lead to a condition called chiasmal syndrome, which is correlated with pituitary adenomas. Polydipsia is just one of the symptoms of diabetes insipidus that accompanies the presence of this type of tumor. Low appetite resulting from the pressure of the tumor can lead to anorexia. Fever is not associated with the presence of a pituitary adenoma. This finding may be associated with other serious neurological conditions if accompanied by the same symptoms (i.e., headaches, visual impairments). These conditions include meningitis or encephalitis.

The nurse is providing discharge instructions for a client who was admitted to the oncology unit due to dehydration and anorexia after chemotherapy treatment. What information should the nurse provide to the client to promote improve the client's nutritional intake at home? A. Prepare the eating area with a pleasant room spray B. Take prescribed pain medication prior to commencing a meal C. Avoid any oral care prior to eating D. Eat uninterrupted by others to eliminate distractions

B. Take prescribed pain medication prior to commencing a meal The client needs to be clean, comfortable, and free of pain for meals, in an environment that is as attractive as possible. Ensuring adequate pain relief in advance of commencing a meal will make the experience more pleasant and tolerable. Pain is correlated with lack of appetite. Oral hygiene before meals helps to improve appetite. Offensive sights, sounds, and odors are eliminated. Creative strategies may be required to make food more palatable, provide enough fluids, and increase opportunities for socialization during meals.

The nurse 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? A. Pituitary gland B. Brain stem C. Cerebellum D. Temporal lobe

C. Cerebellum The cerebellum is the brain structure responsible for balance, coordination and fine muscle control. The tumor is most likely located on or near this brain structure. A tumor located on or near the brain stem would more likely cause changes in autonomic functioning such as blood pressure. The temporal lobe is responsible for language comprehension, behavior, memory, hearing and emotions. A tumor effecting the pituitary gland would result in hormonal changes as this structure is responsible for hormones, growth and reproductive processes in the body.