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

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

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

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 Deep vein thrombosis Pulmonary embolism Spinal metastasis

Intracerebral hemorrhage Explanation: Clients receiving anticoagulant agents, such as low molecular weight heparin, must be closely monitored because of the risk of central nervous system hemorrhage, also known as an intercerebral hemorrhage. Both deep vein thrombosis and pulmonary embolism would be prevented or mitigated by the use of anticoagulant medications such as low molecular weight heparin. The nurse should always consider the risk of these latter problems, however, because the client is clearly at risk for impaired coagulation. Spinal metastasis can result in spinal cord compression, which is considered a medical emergency requiring immediate treatment. In this case, the nurse would observe reports of back pain, extremity weakness, ataxia and/or paralysis.

Low bone mass and osteoporosis Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

Low bone mass and osteoporosis Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

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

Low bone mass and osteoporosis Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

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

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

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

Parkinson disease Explanation: In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

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? Angioma Neuroma Pituitary adenoma Glioblastoma

Pituitary adenoma Explanation: Pituitary adenomas can increased production of several hormones including TSH, ACTH, growth hormone and prolactin. Excessive hormone production is not characteristic of the brain tumors identified in the alternate options.

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

Severe lower back pain Explanation: The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet - usually unilaterally. A herniated disk also may cause sensory and motor loss (such as foot drop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

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

Spinal metastasis Explanation: Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management.

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

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

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

laminectomy. Explanation: The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or may be assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery.