PrepU 70
Which diagnostic is most commonly used for spinal cord compression?
MRI MRI is the most commonly used diagnostic tool, detecting epidural spinal cord compression and metastases.
The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? Drugs administered may not cause the requisite therapeutic effect. Clients take an assortment of different drugs. Clients generally do not adhere to the drug regimen. Drugs administered may cause a wide variety of adverse effects.
Drugs administered may cause a wide variety of adverse effects
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? "Surgical intervention is not very effective for this type of tumor." "This type of tumor has a poor prognosis." "This type of tumor invades brain tissue quickly." "Grade 1 is the most common type of this tumor."
"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 brain & spinal cord. 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.
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action? Keeping a pillow under the client's knees at all times Placing the client in semi-Fowler's position Maintaining bed rest for 72 hours after the laminectomy Turning the client from side to side, using the logroll technique
Turning the client from side to side, using the logroll technique To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the logroll technique. (Twisting after a laminectomy could injure the spine.) After surgery, the nurse shouldn't put anything under the client's knees or place the client in semi-Fowler's position because these actions increase the risk of deep vein thrombosis. Typically, the client is allowed out of bed by the first or second day after a laminectomy.
The nurse educator knows which statement about pituitary adenomas is true? They are most prevalent in the pediatric population. Most of these types of tumors are malignant. Cushing disease can result from a functioning tumor. Men are more likely to be diagnosed with this type of tumor.
Cushing disease can result from a functioning tumor.
During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority? Give the client something to help induce sleep. Change the client's bandages. Notify the client's surgeon. Increase the client's pain medication.
Notify the client's surgeon. If a client recovering from cervical discectomy experiences sudden increased pain, the graft may have extruded, requiring reoperation. The nurse should report this finding promptly to the surgeon. The nurse would not change the bandage or give medicine without a surgeon's order.
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? "There will be less cancer left that might be resistant to chemotherapy." "The surgeon will be able to remove all of the tumor." "My headache and nausea should be lessened somewhat." "Any tissue that was dead will be removed."
"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.
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 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
A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? More back pain than the first postoperative day Paresthesia in the dermatomes near the wounds Urine retention or incontinence Temperature of 99.2° F (37.3° C)
Urine retention or incontinence
A client 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 should ask your physician about that." "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." "You may experience progressive deterioration in all voluntary muscles." "This form of muscular dystrophy is a relatively benign disease that progresses slowly."
"You may experience progressive deterioration in all voluntary muscles." The nurse should tell the client that muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10.
A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.
10 Because each 5 mL contains 50 mg, the client would receive 10 mL for the prescribed dose of 100 mg. To calculate the amount, set up a proportion: 5/50 = x/100; cross multiply and solve for x, which is 10.
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.
An acoustic neuroma is a benign tumor of which cranial nerve?
8 CN most responsible for hearing and balance.
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Parkinson disease Amyotrophic lateral sclerosis Alzheimer disease Huntington disease
Amyotrophic lateral sclerosis Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.
Which medication classification should be avoided in the treatment of brain tumors? Anticoagulants Osmotic diuretics Corticosteroids Anticonvulsants
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.
Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy? Client participates in activities of daily living using adaptive devices. Client demonstrates understanding of the need to adhere to medication therapy. Client verbalizes understanding of the chronic nature of the disorder. Client describes the importance of diagnostic follow-up to evaluate the disorder.
Client participates in activities of daily living using adaptive devices.
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? Paclitaxel Coumadin Decadron Dilantin
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.
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? Core needle biopsy Ultrasonography Computed tomography Magnetic resonance imaging
MRI
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Dysphagia Dysphonia Hypokinesia Micrographia
Dysphonia Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
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. Ensure that the client is free of pain for meals. Place the client near the sounds and smells of meals being prepared. Plan meals for times when the client is rested. Provide the client with foods that he likes. Prepare the client for the insertion of a feeding tube.
Ensure that the client is free of pain for meals. Plan meals for times when the client is rested. Provide the client with foods that he likes.
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 Elimination of distressing signs and symptoms Removal of all or part of the tumor Reduced incidence of recurrence
Improved quality of life The tx of metastatic brain cancer is palliative and involves eliminating or reducing serious symptoms
The nurse is caring for a client with an inoperable brain tumor. What is a major threat to this client? Increased intracranial pressure Decreased intracranial pressure Hypervolemia Hypovolemia
Increased intracranial pressure
Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Imbalanced nutrition: Less than body requirements Ineffective airway clearance Impaired urinary elimination Risk for injury
Ineffective airway clearance
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 DVT PE Spinal metastasis
Intracerebral hemorrhage
What is the only known risk factor for brain tumors? Ionizing radiation Head trauma Use of hair dyes Cellular telephones
Ionizing radiation
A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? Edema associated with the tumor Irritation of the medullary vagal centers Compression of surrounding structures Distortion of pain-sensitive structures
Irritation of the medullary vagal centers Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.
A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? Keeping the head in a neutral position Wearing the cervical collar when sleeping Removing the entire collar when shaving Moving the neck from side to side when the collar is off
Keeping the head in a neutral position
Which topic is most important for the nurse to include in the teaching plan for a client newly diagnosed with Parkinson's disease? Involvement with diversion activities Enhancement of the immune system Establishing balanced nutrition Maintaining a safe environment
Maintaining a safe environment The primary focus in caring for Parkinson's disease is on maintaining a safe environment. Parkinson's disease often has a propulsive gait, characterized by a tendency to take increasingly quicker steps while walking and an inability to stop abruptly without losing balance. Prevention of communicable diseases and establishing a balanced nutrition is encouraged with any chronic disorder. Diversional activities can be helpful in times of stress but not a priority.
What nursing intervention will best assist the client with chorea? Monitor the client on bed rest Assist the client with walking hourly Keep an oral airway at the bedside Administer pain medications every 4 hours
Monitor the client on bed rest
A nurse helps a patient recently diagnosed with a pituitary adenoma understand that: The cause is directly related to prior exposure to radiation. Most tumors are malignant (>90%). Transcranial surgery is usually necessary to remove the tumor. Most tumors produce too much of one or more hormones.
Most tumors produce too much of one or more hormones.
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
Which of the following is a late symptom of spinal cord compression? Paralysis Urinary incontinence Fecal incontinence Urinary retention
Paralysis Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Early symptoms associated with spinal cord compression include bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation).
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. Radiosurgery Craniotomy with debulking Radiation Positron emission tomography (PET) Computer-assisted stereotactic biopsy
Radiosurgery Craniotomy with debulking Radiation
A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? Loss of bowel and bladder control Choreiform movements Suicidal ideations Emotional apathy
Suicidal ideation
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.
The nurse is caring for a client who is experiencing increased intracranial pressure (ICP), resulting from a pituitary adenoma. The nurse should anticipate which intervention will likely be prescribed to help decrease this client's ICP? Transsphenoidal surgery Salvage therapy Anticonvulsant agents Remaining in a side-lying position
Transsphenoidal surgery For clients with pituitary adenomas causing increased ICP, the aim is to reduce the compression on surrounding tissue caused by the size of the tumor. A minimally invasive technique that is used to reduced the size of or remove the tumor is called transsphenoidal surgery. This microsurgery, sometimes paired with stereotactic radiotherapy help to normalize hormonal secretion and relieve symptoms and compression on surrounding structures.
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?
cerebellum
In which location are most brain angiomas located?
cerebellum
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)
Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)?
glutamate
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
logroll client from side to side
Bone density testing in clients with post-polio syndrome has demonstrated osteoarthritis. calcification of long bones. no significant findings. low bone mass and osteoporosis.
low bone mass and osteoporosis.
The nurse teaches the client that corticosteroids will be used to treat his brain tumor to prevent extension of the tumor. facilitate regeneration of neurons. reduce cerebral edema. identify the precise location of the tumor.
reduce cerebral edema.
The nurse teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder? X-linked Autosomal recessive Autosomal dominant Non -repeated HTT gene
Autosomal dominant
In which location are most brain angiomas located? Cerebellum Hypothalamus Thalamus Brainstem
Cerebellum
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? "Every life-saving treatment is administered when treating brain tumors." "Surgical resection of the tumor will decrease intracranial pressure." "Using this procedure will eliminate the need for chemotherapy." "Removing bulk from the tumor will reverse the paralysis."
"Surgical resection of the tumor will decrease intracranial pressure."
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 = 90/50 mm Hg; HR = 75 bpm BP =130/80 mm Hg; HR = 55 bpm BP = 150/90 mm Hg; HR = 90 bpm BP = 175/45 mm Hg; HR = 42 bpm
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.
A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following? Balance and coordination Vision Hearing Cognition
Balance and coordination
The nurse educator is facilitating a class on neurological function with a group of nursing students. When discussing problems that can result from growing brain tumors, the nurse educator should include that clients can experience which neurologic deficits even after surgical resection? Select all that apply. Paralysis Incontinence Aphasia Fever Respiratory infection
Paralysis Incontinence Aphasia Although fever and respiratory infection can result from various factors that influence the hospitalized client, these are not categorized as neurologic deficits. The nurse educator is correct in stating that paralysis, incontinence and aphasia are potential neurological deficits that can result from pressure of growing tumors on surrounding brain structures. The arise from a decreased sensory motor response of the central and peripheral nervous system.
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? "If a corticosteroid has been prescribed, do not take it at the same time as this medication." "If the previous day's dose was forgotten, take two at the regular time the next day." "Suicidal ideation is a common side effect of this medication and should be reported immediately." "Driving a car should be avoided until the you know how this medication effects you."
"Driving a car should be avoided until the you know how this medication effects you."
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? "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." "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." "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." "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."
"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 daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse? "The disease is not hereditary and therefore there is no risk to you." "If one parent has the disorder, there is an 75% chance that you will inherit the disease." "If one parent has the disorder, there is a 50% chance that you will inherit the disease." "The disease is inherited and all offspring of a parent will develop the disease."
"If one parent has the disorder, there is a 50% chance that you will inherit the disease."
A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.
750 First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 75 kg. Next, set up a proportion: 10/1 = x/75; cross multiply and solve for x, which is 750.
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 cerebellar tumor A frontal lobe tumor A motor cortex tumor An occipital lobe tumor
A motor cortex tumor
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Dyskinesia Bradykinesia Micrographia Dysphonia
Dyskinesia
A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. Fluid overload Dysphagia Choking Constipation Anorexia
Dysphagia Choking Constipation
Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia?
Huntington
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. Lung Breast Gastrointestinal tract Prostate Bladder
Lung Breast Gastrointestinal tract
A client who is suspected of having a spinal cord tumor is reporting pain. Upon further assessment, the nurse would anticipate that the client would report that the pain increases when in which position? Supine Prone Side-lying Semi-Fowler's
Prone
The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? Protecting the client from falls Measuring electrolytes Assessing serum cholesterol Range-of-motion exercises
Protecting the client from falls
Nursing students are reviewing the various types of brain tumors. The students demonstrate understanding of the material when they identify which of the following as the most common type? Gliomas Meningiomas Acoustic neuromas Pituitary adenomas
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 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: The tumor is malignant and aggressive. The tumor will cause pressure on the eighth cranial nerve. Growth is slow and symptoms are caused by compression rather than tissue invasion. Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.
Growth is slow and symptoms are caused by compression rather than tissue invasion
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? IICP Dehydration Migraines The tumor is shrinking.
IICP
Which of the following is a hallmark of spinal metastases? Pain Nausea Fatigue Change in level of consciousness (LOC)
Pain
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
A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? Multiple sclerosis Myasthenia gravis Parkinson's disease Huntington's disease
Parkinson's disease
A health care provider needs help in identifying the precise location of a brain tumor. To measure brain activity, as well as to determine structure, the nurse expects the health care provider to order which of the following tests? MRI Computed tomography (CT) Positron-emission tomography (PET) Computer-assisted stereotactic biopsy
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 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 Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management.
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 Radiation therapy Chemotherapy Immunotherapy
Surgery
A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? The muscles will become fatigued and the patient will not be able to chew food or swallow pills. There should not be a problem, since the medication was only delayed by about 2 hours. The patient will go into cardiac arrest. The patient will require a double dose prior to lunch.
The muscles will become fatigued and the patient will not be able to chew food or swallow pills.
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. Reading Writing Understanding language Emotions Memory
Understanding language Emotions Memory 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.
The nurse recognizes which disease as a degenerative neurologic disorder? Huntington disease Paget disease Osteomyelitis Glioma
Huntington disease
The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond? "I am your nurse and caring for you is my obligation. If you no longer want my care, you have to make a request to my supervisor." "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." "I can see you no longer want me as your nurse today. I will ask one of my colleagues to come in to complete the rest of my assessment." "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."
"I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."
A client with post-polio syndrome displays fatigue and decreased muscle strength. How should the nurse best respond to the client? "This will pass, you need to relax." "Once you sleep, you should be fine." "Intravenous immunoglobulin infusion may help you." "These symptoms are not related to your past diagnosis."
"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.
The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? How to exercise How to perform household tasks How to take a bath How to facilitate tasks such as using both hands to hold a drinking glass
How to facilitate tasks such as using both hands to hold a drinking glass
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? Optimizing nutrition Managing muscle weakness Explaining hospice care and services Offering family support groups
Explaining hospice care and services
A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? Ask the client if there is pain on ambulation. Ask if the client can walk. Have the client lie on the back and lift the leg, keeping it straight. Ask if the client has had a bowel movement.
Have the client lie on the back and lift the leg, keeping it straight
A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? Help the client assume a more comfortable position. Administer hydrocodone (Vicodin) as ordered. Provide teaching on nonpharmacologic measures to control pain. Notify the physician of the client's pain.
Help the client assume a more comfortable position. The nurse should first help the client assume a more comfortable position. After doing so, the nurse may administer pain medication as ordered. Next, the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as necessary. If the client's pain isn't relieved after taking these actions, the nurse should notify the physician of the client's pain issues.
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? Hemorrhagic stroke Thyroid disorders Hearing loss Visual loss
Hemorrhagic stroke
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? High corticotropin and low cortisol levels Low corticotropin and high cortisol levels High corticotropin and high cortisol levels Low corticotropin and low cortisol levels
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.
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? Body image disturbance Anxiety Impaired cognition Knowledge deficit
Knowledge deficit Clients with extensive neurologic deficits before surgery usually do not make significant functional recovery, even after successful tumor removal. In this case, the client had already developed bilateral sensory loss in the lower extremities indicating the fairly progressed impact of the tumor on the client's functional ability
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? Provide education regarding adequate pain medication throughout the day Share information about expected symptoms related to growing tumors Instruct the family member to encourage the client to avoid lying in a prone position Tell the family member to get the client to hospital for emergency assessment
Tell the family member to get the client to hospital for emergency assessment
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: The tumor rarely spreads to other parts of the body. Chemotherapy, following surgery, has recently been shown to be a highly effective treatment. Radiation is not an option because of the tumor's location near the brainstem. Surgery can improve survival time but the results are not guaranteed.
Surgery can improve survival time but the results are not guaranteed.
A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approved for the treatment of this symptom? Tetrabenazine (Xenazine) Carbamazepine (Tegretol) phenobarbital Diazepam (Valium)
Tetrabenazine (Xenazine) Tetrabenazine (Xenazine) is the only approved drug for the treatment of the chorea
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. If a dose is missed, the client should take double the amount at the regular time the following day. The client should seek emergency help if nausea or vomiting occur. The client should seek emergency care if he or she develops a fever. Hair loss should be expected when taking the medication.
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.
A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following? The client is having an exacerbation. Medication needs to be adjusted to higher doses. The client is exhibiting signs of medication overdose. The disease has entered the late stages.
The disease has entered the late stages.
A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? Baclofen Riluzole Dantrolene sodium Diazepam
Riluzole
A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? Pain radiating down the posterior thigh Back pain when the knees are flexed Atrophy of the lower leg muscles Homans' sign
Pain radiating down the posterior thigh A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, lower back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis.
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 Slow, shuffling gait Dysphagia and dysphonia Dementia
Rapid, jerky, involuntary movements The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes
A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? Related to visual field deficits Related to difficulty swallowing Related to impaired balance Related to psychomotor seizures
Related to impaired balance
The nurse is caring for a client postoperatively from a spinal tumor resection. The nurse assesses that the client has partial paralysis. What anticipated problems should the nurse include in the client's care plan? Select all that apply. Risk for impaired physical mobility Risk for injury Risk for powerlessness Risk for sexual dysfunction Risk for knowledge deficit
Risk for impaired physical mobility Risk for injury Risk for powerlessness Risk for knowledge deficit
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 Urinary tract infection Knowledge deficit Impaired skin integrity
Spinal cord compression
