PrepU Ch 70: Oncologic and Degenerative Neurologic Disorders

In which location are most brain angiomas located? a. Brainstem b. Cerebellum c. Thalamus d. Hypothalamus

b. Cerebellum Rationale: Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).

The nurse is seeing a client in the oncology outpatient clinic. The client has recently been diagnosed with grade I meningioma. The client asks, "Is there a cure for my condition?" How should the nurse respond? a. "For most clients, surgery is an effective treatment for this type of tumor." b. "This type of tumor is fast growing and difficult to treat." c. "You will need to speak to your doctor regarding questions about your prognosis." d. "Radiation and chemotherapy are good treatment options for this type of tumor."

a. "For most clients, surgery is an effective treatment for this type of tumor." Rationale: During this client interaction, it is important that the nurse provide the newly diagnosed client with facts about the condition and use a method of communicating that helps to reduce the client's anxiety. The nurse can accomplish this by telling the client that the type of tumor that client has been diagnosed with responds well to surgery, because this is true. Grade I meningiomas are the most common type and can be cured by surgery. Radiation and chemotherapy are not used in the treatment of grade I meningiomas. The main treatment is surgery. The nurse should communicate this to the client. To tell the client to speak to the doctor limits the therapeutic effectiveness of the nurse-client relationship. The nurse should provide accurate information about the diagnosis without being too specific. Although the nurse should encourage the client to speak to the doctor, it is important to provide as much client teaching as possible. It is incorrect to tell the client that the tumor is fast growing and difficult to treat. Grade 1 meningiomas are slow growing and respond well to surgery.

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 participates in activities of daily living using adaptive devices. b. Client verbalizes understanding of the chronic nature of the disorder. c. Client demonstrates understanding of the need to adhere to medication therapy. d. Client describes the importance of diagnostic follow-up to evaluate the disorder.

a. Client participates in activities of daily living using adaptive devices. Rationale: 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.

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. Surgery can improve survival time but the results are not guaranteed. b. Radiation is not an option because of the tumor's location near the brainstem. c. Chemotherapy, following surgery, has recently been shown to be a highly effective treatment. d. The tumor rarely spreads to other parts of the body.

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

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? a. The muscles will become fatigued and the patient will not be able to chew food or swallow pills. b. The patient will require a double dose prior to lunch. c. The patient will go into cardiac arrest. d. There should not be a problem, since the medication was only delayed by about 2 hours.

a. The muscles will become fatigued and the patient will not be able to chew food or swallow pills. Rationale: Maintenance of stable blood levels of anticholinesterase medications, such as pyridostigmine, is imperative to stabilize muscle strength. Therefore, the anticholinesterase medications must be administered on time. Any delay in administration of medications may exacerbate muscle weakness and make it impossible for the patient to take medications orally.

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? a. Micrographia b. Hypokinesia c. Dysphonia d. Dysphagia

c. Dysphonia Rationale: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

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? a. "It is not within my scope to discuss this aspect of your care with you. You should talk to your treating primary health care provider about this and discuss options." b. "Seizures are genetic neurological conditions. Do you have anyone in your family with a seizure disorder? If so, this increases the likelihood you will have one." c. "60% of people with brain tumors have seizures. There is a strong chance you will have a seizure at some point and should keep a seizure kit close by." d. "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?"

d. "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?" Rationale: In this case, the client is verbalizing a valid concern about management of the potential manifestation of the brain tumor. The nurse should engage the client by providing fact-based information about the probability of seizures caused by effects of brain tumors. The nurse should further engage in the discussion by evaluating the client's existing understanding of the seizures related to brain tumors and the associated management of this problem. The open-ended manner in which the nurse has asked the question in the correct answer option allows the client to reveal any knowledge deficits or gaps in understanding of the condition. Telling the client there is a strong chance that he or she will have a seizure is countertherapeutic and would serve to increase the client's anxiety. The nurse's aim should be to reduce the client's anxiety related to the diagnosis. Telling the client that seizures are a genetic neurological condition is out of context in this situation. The client is worried about having a seizure because he or she has a brain tumor. The nurse should address the concern in the correct context. The nurse is incorrect when stating having this discussion is not within the nurse's scope of practice. The client's verbalized concern presents an opportunity for the nurse to evaluate the client's understanding of the treatment and management of the condition. The nurse should refer the client back to the primary health care provider if there are any aspects of the client's health history that are unclear.

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: a. Doppler scanning. b. quantitative spectral phonoangiography. c. Doppler ultrasonography. d. electromyography (EMG).

d. electromyography (EMG). Rationale: To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to a. facilitate regeneration of neurons. b. identify the precise location of the tumor. c. prevent extension of the tumor. d. reduce cerebral edema.

d. reduce cerebral edema. Rationale: 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 acoustic neuroma is a benign tumor of which cranial nerve? a. Ninth b. Eighth c. Seventh d. Fifth

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

Which of the following is a hallmark of spinal metastases? a. Fatigue b. Nausea c. Pain d. Change in level of consciousness (LOC)

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

Bone density testing in clients with post-polio syndrome has demonstrated a. low bone mass and osteoporosis. b. no significant findings. c. osteoarthritis. d. calcification of long bones.

a. low bone mass and osteoporosis. Rationale: 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.

What nursing intervention will best assist the client with chorea? a. Keep an oral airway at the bedside b. Administer pain medications every 4 hours c. Monitor the client on bed rest d. Assist the client with walking hourly

c. Monitor the client on bed rest Rationale: Chorea is a rapid, jerky, involuntary, purposeless movement of the extremities that interferes with walking, sitting, and activities of daily living. It can involve facial muscles. For safety reasons, the client should be monitored on bed rest.

Which anticholinergic agent is used to control tremor and rigidity in Parkinson disease? a. Benztropine Mesylate b. Bromocriptine mesylate c. Amantadine d. Levodopa

a. Benztropine Mesylate Rationale: Benztropine Mesylate is an anticholinergic agent used to control tremor and rigidity in Parkinson disease. Bromocriptine mesylate is a dopamine agonist. Amantadine is an antiviral agent. Levodopa is a dopaminergic.

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. a. Anorexia b. Constipation c. Choking d. Fluid overload e. Dysphagia

b. Constipation c. Choking e. Dysphagia Rationale: Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Fluid overload and anorexia are not specifically related to Parkinson's disease.

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. "My headache and nausea should be lessened somewhat." c. "Any tissue that was dead will be removed." d. "The surgeon will be able to remove all of the tumor."

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

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

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

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? a. Dysphagia and dysphonia b. Slow, shuffling gait c. Dementia d. Rapid, jerky, involuntary movements

d. Rapid, jerky, involuntary movements Rationale: The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes (Aubeeluck & Wilson, 2008).

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. Cerebellum b. Motor cortex c. Occipital lobe d. Frontal lobe

a. Cerebellum Rationale: 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.

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. Increased intracranial pressure b. The tumor is shrinking. c. Migraines d. Dehydration

a. Increased intracranial pressure Rationale: 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.

A nurse suspects that a client has Huntington disease based on which assessment finding? a. Chorea b. Dementia c. Disorganized gait d. Slurred speech

a. Chorea Rationale: 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 client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? a. Irritation of the medullary vagal centers b. Edema associated with the tumor c. Compression of surrounding structures d. Distortion of pain-sensitive structures

a. Irritation of the medullary vagal centers Rationale: 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.

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. Decadron b. Paclitaxel c. Dilantin d. Coumadin

d. Coumadin Rationale: 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 nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? a. More back pain than the first postoperative day b. Paresthesia in the dermatomes near the wounds c. Urine retention or incontinence d. Temperature of 99.2° F (37.3° C)

c. Urine retention or incontinence Rationale: Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in back pain is more common because on the second postoperative day the long-acting local anesthetic, which may have been injected during surgery, will wear off. Although paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if the temperature reaches 101° F (38.3° C).

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. Acoustic neuromas b. Pituitary adenomas c. Meningiomas d. Gliomas

d. Gliomas Rationale: 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.

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. Optimizing nutrition b. Managing muscle weakness c. Explaining hospice care and services d. Offering family support groups

c. Explaining hospice care and services Rationale: 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.

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? a. Ask if the client has had a bowel movement. b. Ask the client if there is pain on ambulation. c. Have the client lie on the back and lift the leg, keeping it straight. d. Ask if the client can walk.

c. Have the client lie on the back and lift the leg, keeping it straight. Rationale: A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.

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 Visual loss b. Thyroid disorders c. Hearing loss d. Hemorrhagic stroke

d. Hemorrhagic stroke Rationale: 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.

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. An occipital lobe tumor b. A frontal lobe tumor c. A motor cortex tumor d. A cerebellar tumor

c. A motor cortex tumor Rationale: 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.

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? a. Creutzfeldt-Jakob disease b. Multiple sclerosis c. Parkinson disease d. Huntington disease

c. Parkinson disease Rationale: 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.

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? a. Removing the entire collar when shaving b. Keeping the head in a neutral position c. Moving the neck from side to side when the collar is off d. Wearing the cervical collar when sleeping

b. Keeping the head in a neutral position Rationale: After a cervical discectomy, the client typically wears a cervical collar. The client should be instructed to keep his head in a neutral position and wear the collar at all times unless the physician has instructed otherwise. The front part of the collar is removed for shaving and the neck should be kept still while the collar is open or off.

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. Minimized functional deterioration in the client. c. Genetic testing will identify specific gene mutations. d. Client will complete end-of-life decisions.

b. Minimized functional deterioration in the client. Rationale: 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 client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? a. Emotional apathy b. Loss of bowel and bladder control c. Suicidal ideations d. Choreiform movements

c. Suicidal ideations Rationale: 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 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. Everolimus c. Bevacizumab d. Mannitol

d. Mannitol Rationale: 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.

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? a. "The disease is not hereditary and therefore there is no risk to you." b. "If one parent has the disorder, there is a 50% chance that you will inherit the disease." c. "If one parent has the disorder, there is an 75% chance that you will inherit the disease." d. "The disease is inherited and all offspring of a parent will develop the disease."

b. "If one parent has the disorder, there is a 50% chance that you will inherit the disease." Rationale: Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. The disease affects approximately 1 in 10,000 men or women of all races at midlife. It is transmitted as an autosomal dominant genetic disorder; therefore, each child of a parent with Huntington disease has a 50% risk of inheriting the disorder (Ha & Fung, 2012).

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. Place the client near the sounds and smells of meals being prepared. b. Ensure that the client is free of pain for meals. c. Provide the client with foods that he likes. d. Plan meals for times when the client is rested. e. Prepare the client for the insertion of a feeding tube.

b. Ensure that the client is free of pain for meals. c. Provide the client with foods that he likes. d. Plan meals for times when the client is rested. Rationale: 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 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 invades brain tissue quickly." c. "Grade 1 is the most common type of this tumor." d. "This type of tumor has a poor prognosis."

c. "Grade 1 is the most common type of this tumor." Rationale: 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.

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. Radiosurgery b. Computer-assisted stereotactic biopsy c. Positron emission tomography (PET) d. Radiation e. Craniotomy with debulking

a. Radiosurgery d. Radiation e. Craniotomy with debulking Rationale: 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.

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? a. Provide teaching on nonpharmacologic measures to control pain. b. Help the client assume a more comfortable position. c. Administer hydrocodone (Vicodin) as ordered. d. Notify the physician of the client's pain.

b. Help the client assume a more comfortable position. Rationale: 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.

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. Adrenocorticotropic hormone b. Thyroid-stimulating hormone c. Prolactin d. Growth hormone

b. Thyroid-stimulating hormone Rationale: 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 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. The client should ensure no one else handles the medication. b. If a dose is missed, the client should take double the amount at the regular time the following day. c. Hair loss should be expected when taking 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.

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

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? a. Amyotrophic lateral sclerosis b. Parkinson disease c. Huntington disease d. Alzheimer disease

a. Amyotrophic lateral sclerosis Rationale: 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.

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? a. Dyskinesia b. Micrographia c. Bradykinesia d. Dysphonia

a. Dyskinesia Rationale: Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.

A client is diagnosed with amyotrophic lateral sclerosis (ALS) in the early stages. Which medication would the nurse most likely expect to be prescribed as treatment? a. Riluzole b. Benztropine mesylate c. Amantadine d. Bromocriptine

a. Riluzole Rationale: Riluzole is the only medication that is approved for use in treating ALS. It is used for its neuroprotective effect in the early stages of the disease. Benztropine amantadine and bromocriptine are used to treat Parkinson's disease.

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? a. Spinal metastasis b. Lumbar sacral strain c. The development of a skin ulcer from the radiation d. Hematoma formation

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

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. Skin breakdown b. Bowel incontinence c. Respiratory dysfunction d. Hemorrhage

c. Respiratory dysfunction Rationale: 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.

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? a. Pain radiating down the posterior thigh b. Atrophy of the lower leg muscles c. Homans' sign d. Back pain when the knees are flexed

a. Pain radiating down the posterior thigh Rationale: 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. Reference:

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 Core needle biopsy b. Magnetic resonance imaging c. Ultrasonography d. Computed tomography

b. Magnetic resonance imaging Rationale: 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.

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

b. laminectomy. Rationale: 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.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? a. Imbalanced nutrition: Less than body requirements b. Risk for injury c. Ineffective airway clearance d. Impaired urinary elimination

c. Ineffective airway clearance Rationale: In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes the highest priority. Although Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, and Risk for injury are also appropriate nursing diagnoses, they aren't immediately life-threatening.

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

c. Severe lower back pain Rationale: 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 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. Epidural space d. Implanted port

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

The nurse teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder? a. X-linked b. Autosomal dominant c. Non -repeated HTT gene d. Autosomal recessive

b. Autosomal dominant Rationale: 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.

A nurse is providing care to a client diagnosed with a spinal cord tumor. Based on the nurse's understanding about treatment for this type of tumor, the nurse would most likely expect to develop a teaching plan related to which therapy? a. Surgery b. Radiation therapy c. Chemotherapy d. Spinal cord decompression

a. Surgery Rationale: Treatment of spinal cord tumors depends on the type, location of the tumor, the presenting symptoms, and physical status of the client. Surgical intervention, if appropriate, is the primary treatment for most tumors. Other treatment modalities include partial removal of the tumor with decompression of the spinal cord. For metastatic lesions of the spine, radiation therapy can be used to decrease the size of the tumor. Chemotherapy options are limited due to the blood-brain barrier.

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. Eat uninterrupted by others to eliminate distractions d. Avoid any oral care prior to eating

b. Take prescribed pain medication prior to commencing a meal Rationale: 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.

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. "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." c. "You should ask your physician about that." d. "You may experience progressive deterioration in all voluntary muscles."

d. "You may experience progressive deterioration in all voluntary muscles." Rationale: 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 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 difficulty swallowing c. Related to visual field deficits d. Related to impaired balance

d. Related to impaired balance Rationale: 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.

A client has just returned from surgery after undergoing a lumbar laminectomy. Which of the following would be most important to do when positioning the client in bed? a. Allowing the client to sit up at the edge of the bed b. Maintaining full knee flexion when lying on the side c. Keeping the knees flat with the head on a pillow d. Using a logrolling motion to change positions

d. Using a logrolling motion to change positions Rationale: After a laminectomy, logrolling is used to change the client's position. When in bed, a pillow is placed under the client's head and the knee rest is elevated slightly to relax the back muscles. When lying on his or her side, extreme knee flexion is avoided. Sitting is discouraged except for defecation.

A client has undergone a cervical discectomy. The nurse determines which interventions are essential to teach the client? Select all that apply. a. Sit as much as possible; standing can cause pain b. Avoid twisting or flexing the neck c. Keep staples or sutures clean and dry d. Cover incision with dry dressing e. Do not remove dressing until the next visit f. Call health care provider if the area is red or irritated

b. Avoid twisting or flexing the neck c. Keep staples or sutures clean and dry d. Cover incision with dry dressing e. Do not remove dressing until the next visit f. Call health care provider if the area is red or irritated Rationale: The client needs to keep staples or sutures clean and dry and covered with a dry dressing. Symptoms of infection should be reported to the health care provider. Twisting and flexing of the neck should be avoided. The client can remove the dressing to change it. The client should not sit or stand for longer than half an hour at a time.

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

a. "Driving a car should be avoided until the you know how this medication effects you." Rationale: 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.