Chapter 65: Management of Patients with Oncologic or Degenerative Neurologic Disorders

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

dyskinesia

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

Riluzole

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

magnetic resonance imaging

A client with a malignant glioma is scheduled for surgery. The client demonstrates a need for additional teaching about the surgery when he states which of the following?

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

A client with post-polio syndrome displays fatigue and decreased muscle strength. How should the nurse best respond to the client?

"Intravenous immunoglobulin infusion may help you."

A nurse is conducting a presentation about brain cancer for a local community group. During the presentation, one of the group members asks, "What causes brain tumors?" Which response by the nurse would be most appropriate?

"The cause of most brain tumors is still really not known."

The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond?

"There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?"

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

Corpus callosum.

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?

Amyotrophic lateral sclerosis

Which medication classification should be avoided in the treatment of brain tumors?

Anticoagulants

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

Autosomal dominant

The nurse is caring for a client who was diagnosed with a glioma 5 months ago. Today, the client was brought to the emergency department by his caregiver because he collapsed at home. The nurse suspects late signs of rising intracranial pressure (ICP) when which blood pressure and pulse readings are noted?

BP = 175/45 mm Hg; HR = 42 bpm

The nurse responds to the call light of a client who has had a cervical discectomy earlier in the day. The client states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action?

Call the surgeon to report the client's pain.

Which of the following diagnostic studies provides visualization of cerebral blood vessels?

Cerebral angiography

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery?

Cerebrospinal fluid leakage

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?

Coumadin

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease?

Drugs administered may cause a wide variety of adverse effects.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?

Dysphonia

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

Eighth

The nurse is caring for a client with mid-to-late stage of an inoperable brain tumor. What teaching is important for the nurse to do with this client?

Explaining hospice care and services

The greatest risk of seizures for clients with brain tumors occurs in those who have tumors in which regions of the brain? Select all that apply.

Frontal Parietal Temporal

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify?

Improved quality of life

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

Glutamate

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that:

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

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

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

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?

Increased intracranial pressure

While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action?

Inform the surgeon of the possibility of a dural leak.

What is the only known risk factor for brain tumors?

Ionizing radiation

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

Irregular respirations

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following?

Irritation of the medullary vagal centers

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan?

Knowledge deficit

Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication?

Low bone mass and osteoporosis

Which of the following is a common cancer that metastasizes to the spinal cord? Select all that apply.

Lung Prostate Breast

Which diagnostic is most commonly used for spinal cord compression?

Magnetic resonance imaging (MRI)

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?

Minimized functional deterioration in the client.

During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority?

Notify the client's surgeon.

A client newly diagnosed with Huntington diease asks for information concerning management of symptoms. Which action would the nurse first take to address this request?

Perform a focused assessment on the client's needs and capabilities.

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

Pituitary adenoma

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?

Positron emission tomography (PET)

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits?

Rapid, jerky, involuntary movements

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

Severe lower back pain

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

Spinal cord compression

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor?

Spinal metastasis

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client?

Surgery

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following?

The disease has entered the late stages.

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

Thyroid-stimulating hormone

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors?

They can affect vital functioning.

The nurse is seeing a client who is suspected of having a glioblastoma multiforme tumor. The nurse anticipates the client will require which diagnostic test to confirm the client has this form of brain tumor?

Tissue biopsy

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

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

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?

When the client is resting

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

laminectomy.

When caring for a client diagnosed with a brain tumor of the parietal lobe, the nurse expects to find:

tactile agnosia.

The nurse is providing discharge instructions for a client who was admitted to the oncology unit due to dehydration and anorexia after chemotherapy treatment. What information should the nurse provide to the client to promote improve the client's nutritional intake at home?

Take prescribed pain medication prior to commencing a meal

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:

electromyography (EMG).

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

Intracerebral hemorrhage

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance?

Make sure the client is sitting with the head of bed elevated to 90 degrees.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

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

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:

Surgery can improve survival time but the results are not guaranteed.

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.

The client should ensure no one else handles the medication. The client should seek emergency care if he or she develops a fever. Hair loss should be expected when taking the medication.

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.

Polydipsia Polyuria Disturbed sleep Impairment of visual field

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches?

Increased intracranial pressure

A client is suspected of having a spinal cord tumor. What diagnostic study would the nurse include in the client teaching?

Magnetic resonance imaging scan