Chapter 44: Nursing Management: Patients With Oncologic Disorders of the Brain and Spinal Cord
A female patient is admitted for evaluation of a cerebral metastasis from a primary site. When reviewing her history, what would be the MOST likely primary site? A) Lung B) Prostate C) renal D) Uterus
LUNG
A patient who has been diagnosed with a brain tumor is being cared for in the neurological intensive care unit (ICU) because of a sudden exacerbation of the signs and symptoms of his neoplasm. Which of the following would be indicative of increased intracranial pressure (ICP)? A)Epistaxis B)Severe headache C)Increased jugular venous pressure (JVP) D)Electrocardiographic (ECG) changes
B)Severe headache
Intracerebral tumors - There is 5 - A - G - O - E - M -
Intracerebral tumors Gliomas—infiltrate any portion of the brain: - Astrocytomas (grades I and II) - Glioblastoma multiforme (astrocytoma grades III and IV) - Oligodendrocytoma (low and high grades) - Ependymoma (grades I to IV) - Medulloblastoma
A patient with an inoperable brain tumor has been told that he has a short life expectancy. On what aspects of assessment and care should the home health nurse focus? Select all that apply. A)Pain control B)Management of treatment complications C)Interpretation of diagnostic tests D)Assistance with self-care E)Administration of treatments
Ans: A, B, D, E A)Pain control B)Management of treatment complications D)Assistance with self-care E)Administration of treatments Feedback: Home care needs and interventions focus on four major areas: palliation of symptoms and pain control, assistance in self-care, control of treatment complications, and administration of specific forms of treatment, such as parenteral nutrition. Interpretation of diagnostic tests is normally beyond the purview of the nurse.
A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position the patient in what position? - In the reverse Trendelenburg position - In the Trendelenburg position - In a flat side-lying position - In the lithotomy position
Correct response: In a flat side-lying position Explanation: After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The lithotomy position, the Trendelenburg position, and the reverse Trendelenburg position are inappropriate for this patient.
A 13-year-old patient is admitted to the pediatric unit with a suspected brain tumor. The nurse should understand that which diagnostic test is the most helpful in the diagnosis of brain tumors? - Computed tomography (CT) scan - Brain biopsy - Magnetic resonance imaging (MRI) - Blood work with adrenocorticotropic hormone (ACTH) levels
Correct response: Magnetic resonance imaging (MRI) Explanation: An MRI is the most helpful in the diagnosis of brain tumors. Its use has resulted in the detection of smaller lesions; it is particularly helpful in detecting tumors in the brainstem and pituitary regions, where bone interferes with CT. A brain biopsy or blood work with ACTH levels does not diagnose brain tumors.
An older adult patient exhibiting clinical manifestations of a brain tumor is admitted to the hospital for testing. What tumor types does the nurse know are commonly seen in the older adult? - Anaplastic astrocytoma - Ependymoma - Glioblastoma - Cerebral metastasis from other sites - Medulloblastoma
Correct response: - Anaplastic astrocytoma - Cerebral metastasis from other sites - Glioblastoma Explanation: The most frequent tumor types in the older adult are anaplastic astrocytoma, glioblastoma, and cerebral metastases from other sites.
A patient with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize? A)Assessment of peripheral nervous function B)Assessment of cranial nerve function C)Assessment of nutritional status D)Assessment of respiratory status
Ans: C) Assessment of nutritional status Feedback: Cachexia is a wasting syndrome of weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite. Consequently, nutritional assessment is paramount.
A client with a brain tumor is experiencing changes in cognition that require the nurse to reorient the client frequently. When performing this task, which devices would be appropriate for the nurse to use? Select all that apply. - Client's clothing - Common words - Calendar - Picture of the client's family - Clock
Correct response: Client's clothing Picture of the client's family Clock Calendar Explanation: Clients with changes in cognition caused by their lesions require frequent reorientation and the use of orienting devices (e.g., personal possessions, photographs, lists, and a clock). Words would not be as helpful as items that are familiar to the client.
A client is DX with an acoustic neuroma. Which manifestations would the nurse except to find? Select all that apply. A) Tinnitus B) Vertigo C) Staggering Gait D) Seizures E) Headache
A) Tinnitus B) Vertigo C) Staggering Gait
A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in health status would the nurse attribute to the patient's metastatic brain disease? A)Chronic pain B)Respiratory distress C)Fixed pupils D)Personality changes
Ans: D)Personality changes Feedback: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. Pain, respiratory distress, and fixed pupils are not among the more common neurologic signs and symptoms of metastatic brain disease.
What interventions will best help the client with Huntington disease relieve anxiety and increase communication? Select all that apply. - Use an interpreter. - Consult with a speech therapist. - Always have family present. - Talk as little as possible. - Use biofeedback.
Correct response: Use biofeedback. Consult with a speech therapist. Explanation: Using biofeedback and relaxation therapy may help to decrease stress and help with communication. A speech therapist can help maintain and prolong communication abilities as well. An interpreter is not needed and the client should be encouraged to talk. Family presence is not essential, but the nurse should learn how the client expresses needs and wants, especially if the client is nonverbal.
A patient has been admitted to the neurological unit from the PACU after successful neurosurgery to remove a brain tumor. The nurse's admitting assessment reveals that the patient's gag reflex has not yet fully returned. The nurse should recognize that this assessment finding has the potential to cause which of the following nursing diagnoses? A)Risk for aspiration B)Impaired spontaneous ventilation C)Dysfunctional ventilator weaning response D)Imbalanced nutrition: less than body requirements
A)Risk for aspiration
The nurse educator is discussing neoplasms with a group of recent graduates. The educator explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue. The physiologic changes that result can cause what pathophysiologic events? Select all that apply. A)Intracranial hemorrhage B)Infection of cerebrospinal fluid C)Increased ICP D)Focal neurologic signs E)Altered pituitary function
C)Increased ICP D)Focal neurologic signs E)Altered pituitary function Feedback: The effects of neoplasms are caused by the compression and infiltration of tissue. A variety of physiologic changes result, causing any or all of the following pathophysiologic events: increased ICP and cerebral edema, seizure activity and focal neurologic signs, hydrocephalus, and altered pituitary function.
The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response? - "Your tumor is from nerve tissue somewhere in your body." - "Your tumor originated from cells and structures within the brain." - "Your tumor is pituitary in origin." - "Your tumor originated from somewhere outside the central nervous system."
Correct response: "Your tumor originated from cells and structures within the brain." Explanation: Primary brain tumors originate from cells and structures within the brain. Secondary brain tumors are metastatic tumors that originate somewhere else in the body. The scenario does not indicate that the patient's tumor is a pituitary tumor or a neuroma.
A patient is diagnosed with an intracerebral tumor. The nurse knows that the diagnosis may include which of the following? Select all that apply. - Ependymoma - Acoustic neuroma - Medulloblastoma - Astrocytoma - Meningioma
Correct response: - Astrocytoma - Ependymoma - Medulloblastoma Explanation: Glial tumors, the most common type of intracerebral brain neoplasm, are divided into many categories, including astrocytomas, ependymomas, and medulloblastomas. Meningiomas occur on the meninges and acoustic neuromas on the eight cranial nerve, and thus are not intracerebral tumors.
A client with a brain tumor is exhibiting papilledema. When reviewing the client's history, which information would the nurse correlate with this finding? Select all that apply. - Double vision - Aphasia - Swaying gait - Visual field deficit - Enhanced visual acuity
Correct response: - Double vision - Visual field deficit Explanation: Papilledema is associated with visual disturbances, such as decreased visual acuity, diplopia (double vision), and visual field deficits. It is not associated with a swaying gait or aphasia.
A 37-year-old male is brought to the clinic by his wife because the patient is experiencing loss of motor function and sensation. After initial neurological assessment, the health care provider suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In preparation for diagnostic studies, the nurse will inform the patient that the most commonly used study to diagnosis spinal cord compression from a tumor is what? - A magnetic resonance imaging (MRI) scan - An ultrasound - A computed tomography (CT) scan - An X-ray
Correct response: A magnetic resonance imaging (MRI) scan Explanation: The MRI scan is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.
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 - Bladder - Prostate
Correct response: Lung Breast Gastrointestinal tract Explanation: Cancer can spread to the spinal cord from any primary site. However, the three most common cancers that metastasize to the spinal cord are lung, breast, and those of the gastrointestinal tract.
The nurse is planning the care of a patient who has been admitted to the hospital for surgical treatment of prostate cancer that has metastasized to his spine. When planning nursing care that is specific to this patient's spinal metastasis, what outcome should the nurse identify? A)The patient will explain the importance of exercise in his recovery. B)The patient will maintain full range of motion. C)The patient will perform activities of daily living comparable to his prediagnosis abilities. D)The patient will state that pain control is adequate.
D)The patient will state that pain control is adequate.
The nurse is writing a care plan for a patient with brain metastases. Following a thorough assessment, the nurse decides that an appropriate nursing diagnosis is "Anxiety related to lack of control over the health care needs and situation." In establishing this plan of care for the patient, the nurse will identify what measure as appropriate for the care of this patient? - The patient will receive antianxiety medications every 4 hours. - The patient will be encouraged to verbalize concerns related to the disease and its treatment. - The patient will begin a busy schedule of therapy, so that he will forget about the anxiety. - The patient's family will be instructed on measures to implement when providing care for the patient.
Correct response: The patient will be encouraged to verbalize concerns related to the disease and its treatment. Explanation: Patients need the opportunity to exercise some control over their situation. A sense of mastery can be gained as they learn to understand the disease and its treatment and how to deal with their feelings. Distraction, assuming care responsibilities, and administering medications will not allow the patient to gain some control over his situation or discuss his feelings.
Corticosteroids are used in the treatment of brain tumors for which of the following clinical manifestations? Select all that apply. - Personality changes - Cerebral edema - Seizures - Headache - Altered level of consciousness
Correct response: - Cerebral edema - Headache - Altered level of consciousness Explanation: Corticosteroids are used during treatment to reduce cerebral edema and reduce side effects of treatment, such as nausea and vomiting. They are also helpful in relieving headache and alterations in level of consciousness. Antiseizure agents are used to treat seizures if they occur. Corticosteroids are not used for personality changes associated with brain tumors.
A client diagnosed with a brain tumor is exhibiting focal symptoms. Which assessment findings are the nurse likely to note? Select all that apply. - Vomiting - Sensory loss - Visual changes - Aphasia - Muscle weakness
Correct response: Muscle weakness Sensory loss Aphasia Visual changes Explanation: Common focal, or localized, symptoms include muscle weakness, sensory loss, aphasia, and visual changes. When specific regions of the brain are affected, additional local signs and symptoms occur, such as motor abnormalities, changes in hearing, alterations in cognition, and language disturbances. Vomiting would be considered a generalized symptom.
A male patient with a metastatic brain tumor is having a generalized seizure and begins vomiting. What should the nurse do first? A)Perform oral suctioning. B)Page the physician. C)Insert a tongue depressor into the patient's mouth. D)Turn the patient on his side.
D)Turn the patient on his side. Feedback: The nurse's first response should be to place the patient on his side to prevent him from aspirating emesis. Inserting something into the seizing patient's mouth is no longer part of a seizure protocol. Obtaining supplies to suction the patient would be a delegated task. Paging or calling the physician would only be necessary if this is the patient's first seizure.
The nurse is caring for a client who is currently under medical investigation for a pituitary adenoma. The nurse anticipates the client will likely report which symptoms that are consistent with this type of brain tumor? Select all that apply. - Impairment of visual field - Seizures - Polyuria - Disturbed sleep - Polydipsia
Correct response: - Polydipsia - Polyuria - Disturbed sleep - Impairment of visual field Explanation: Pressure from a pituitary adenoma may be exerted on the optic nerves, optic chiasm, optic tracts, hypothalamus, or the third ventricle. Headache is a common symptom; there can also be visual dysfunction including loss of visual field, the development of diabetes insipidus including symptoms such as excessive thirst and urination. Sleep disturbances are reported and result from the development of diabetes insipidus. Seizures are a common finding with angioma brain tumors.
Which of the following are clinical manifestations associated with increased intracranial pressure (ICP)? Select all that apply. - Headache - Angina - Nausea with or without vomiting - Papilledema - Seizures
Correct response: - Seizures - Nausea with or without vomiting - Papilledema - Headache Explanation: Symptoms of increased intracranial pressure include headache, nausea with or without vomiting, and papilledema. Angina is not associated with increased ICP.
A male patient presents at the free clinic with complaints of impotency. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect? A)Prolactinoma B)Angioma C)Glioma D)Adrenocorticotropic hormone (ACTH)-producing adenoma
Ans: A)Prolactinoma Feedback: Male patients with prolactinomas may present with impotence and hypogonadism. An ACTH-producing adenoma would cause acromegaly. The scenario contains insufficient information to know if the tumor is an angioma, glioma, or neuroma.
A client who has a pituitary adenoma would report which symptoms related to the presence of this type of tumor? Select all that apply. - Fever - Chiasmal syndrome - Morning headaches - Anorexia - Polydipsia
Correct response: Morning headaches Chiasmal syndrome Polydipsia Anorexia Explanation: Common symptoms reported in association with the diagnosis of a pituitary adenoma include headaches in the morning, and changes in the visual field resulting from pressure on the optic nerves, optic chiasm and optic tracts. It is the pressure on the optic chiasm that can lead to a condition called chiasmal syndrome, which is correlated with pituitary adenomas. Polydipsia is just one of the symptoms of diabetes insipidus that accompanies the presence of this type of tumor. Low appetite resulting from the pressure of the tumor can lead to anorexia. Fever is not associated with the presence of a pituitary adenoma. This finding may be associated with other serious neurological conditions if accompanied by the same symptoms (i.e., headaches, visual impairments). These conditions include meningitis or encephalitis.
A patient, diagnosed with cancer of the lung, has just been told that she has metastases to the brain. The family should be aware that the neurologic signs and symptoms of metastatic brain disease are most often what? - Bradycardia - Increase in diastolic blood pressure - Temperature greater than 100.5°F - Personality changes
Correct response: Personality changes Explanation: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. These problems can be devastating to both patient and family. Bradycardia, elevated temperature, and an increase in diastolic blood pressure are not typical neurologic signs and symptoms of metastatic brain disease.
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. - Writing - Understanding language - Emotions - Reading - Memory
Correct response: Understanding language Emotions Memory Explanation: 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.
A nurse is assessing a patient with an acoustic neuroma who has been recently admitted to an oncology unit. What symptoms is the nurse likely to find during the initial assessment? A)Loss of hearing, tinnitus, and vertigo B)Loss of vision, change in mental status, and hyperthermia C)Loss of hearing, increased sodium retention, and hypertension D)Loss of vision, headache, and tachycardia
Ans: A Feedback: An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. The patient with an acoustic neuroma usually experiences loss of hearing, tinnitus, and episodes of vertigo and staggering gait. Acoustic neuromas do not cause loss of vision, increased sodium retention, or tachycardia.
A 25-year-old female patient with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the patient is not receiving treatment for her brain metastases, what is the nurse's most appropriate action? A)Promoting the patient's functional status and ADLs B)Ensuring that the patient receives adequate palliative care C)Ensuring that the family does not tell the patient that her condition is terminal D)Promoting adherence to the prescribed medication regimen
Ans: B) Ensuring that the patient receives adequate palliative care Feedback: Patients with intracerebral metastases who are not treated have a steady downhill course with a limited survival time, whereas those who are treated may survive for slightly longer periods, but for most cure is not possible. Palliative care is thus necessary. This is a priority over promotion of function and the family should not normally withhold information from the patient. Adherence to medications such as analgesics is important, but palliative care is a high priority.
A patient's brain tumor has been manifested by seizures that have become more frequent and severe in recent days. The patient has been scheduled for neurosurgery but the nurse is nonetheless making changes to the patient's preoperative nursing care plan. The patient's seizures should cause the nurse to prioritize which of the following nursing diagnoses? A) Acute pain related to seizure activity B) Risk for injury related to seizures C) Impaired memory related to seizure activity D) Imbalanced nutrition: less than body requirements related to seizures
B) Risk for injury related to seizures
A 64-year-old woman has been admitted to the neurological unit after being diagnosed with a brain tumor. The woman is slated for neurosurgery the following day, and the woman's daughter has come to the hospital from out of state. After visiting her mother for the first time since she was diagnosed, the daughter is distraught and tells the nurse, "My mother has always been one of the kindest, most considerate people, and I don't remember her ever being so abrasive." How should the nurse best respond to the daughter's statement? - "It's most helpful if you can accept her the way she is now, even if it's more difficult than in the past." - "Your mother has received a very stressful diagnosis, and she's likely still processing it." - "Your mother may have been experiencing a partial seizure when she was speaking to you." - "Those personality changes are probably a result of the tumor's effect on her brain."
Correct response: "Those personality changes are probably a result of the tumor's effect on her brain." Explanation: Personality changes are a common manifestation of brain tumors and result from organic brain changes. Stress and seizures are less likely to underlie the behaviors the daughter noticed. It would be inappropriate to reprimand the daughter or to downplay her observations.
While reviewing the nursing documentation on a patient on the neurological unit, the nurse notes that the patient complained of a headache several times over the previous shift. How can the nurse differentiate between a headache that is caused by a brain tumor and a headache that is caused by meningitis or encephalitis? - Assess the active and passive range of motion of the patient's neck. - Assess for the presence of a fever. - Assess the patient's carotid pulses bilaterally. - Assess the patient's orientation to person, place, and time.
Correct response: Assess for the presence of a fever. Explanation: When the patient complains of a headache, the nurse assesses the patient's temperature. The nurse knows that fever with headache is associated with an infectious process such as meningitis or encephalitis, whereas headache without fever is associated with a tumor or intracerebral bleeding.
A patient diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the patient's care, the nurse should be aware that the effects of the tumor will primarily depend on what variable? A)Whether the tumor utilizes aerobic or anaerobic respiration B)The specific hormones secreted by the tumor C)The patient's pre-existing health status D)Whether the tumor is primary or the result of metastasis
Ans: B)The specific hormones secreted by the tumor Feedback: Functioning pituitary tumors can produce one or more hormones normally produced by the anterior pituitary and the effects of the tumor depend largely on the identity of these hormones. This variable is more significant than the patient's health status or whether the tumor is primary versus secondary. Anaerobic and aerobic respiration is not relevant.
A patient who has been experiencing numerous episodes of unexplained headaches and vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the patient's vomiting is most consistent with a brain tumor? A)The patient's vomiting is accompanied by epistaxis. B)The patient's vomiting does not relieve his nausea. C)The patient's vomiting is unrelated to food intake. D)The patient's emesis is blood-tinged.
Ans: C) The patient's vomiting is unrelated to food intake. Feedback: Vomiting is often unrelated to food intake if caused by a brain tumor. The presence or absence of blood is not related to the possible etiology and vomiting may or may not relieve the patient's nausea.
A patient has been admitted to the neurological ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. What is a priority part of the nurse's preoperative assessment of this patient? - Ability to chew - Sensory perception - The gag reflex - Corneal reflex
Correct response: The gag reflex Explanation: Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes teaching the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. The ability to chew and the corneal reflex would be assessed, and so would sensory perception on the face, but none of them is more important than the gag reflex.
The nurse educator is testing a group of nursing students about various types of brain tumors and their clinical manifestations. The students are correct when stating tumors located in the cerebellar region of the brain produce which symptoms? Select all that apply. - Staggering gait - Visual hallucinations - Abnormal eye movements - Muscle incoordination - Apathetic mental attitude
Correct response: - Staggering gait - Muscle incoordination - Abnormal eye movements Explanation: A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction. Visual hallucination are associated with occipital lobe tumors. An apathetic mental attitude can manifest from a tumor in the motor cortex of the frontal lobe.
A 30-year-old female patient has been referred to a specialist by her primary care provider because she has recently developed fat pads at the base of her neck, an increasingly round face, and striae at various locations. The patient's signs of illness have been attributed to a brain tumor. What type of brain tumor is most likely to result in these changes to the woman's physical appearance? - Meningioma - Pituitary adenoma - Glioma - Acoustic neuroma
Correct response: Pituitary adenoma Explanation: Adrenocorticotropic hormone (ACTH)-producing pituitary adenomas result in Cushing's disease, which is characterized by signs and symptoms that include a "buffalo hump," a rounded face, and striae.
The nurse is 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 sexual dysfunction - Risk for knowledge deficit - Risk for impaired physical mobility - Risk for powerlessness - Risk for injury
Correct response: Risk for impaired physical mobility Risk for injury Risk for powerlessness Risk for knowledge deficit Explanation: The change in the client's muscle strength will effect the client's ability to carry out activities that he or she was once used to being able to perform independently. Due to the partial paralysis, the client is now at risk for impaired physical mobility related to a decreased range of motion. The client is at risk for injury due to a possible unsteady gait. The development of partial paralysis is a loss for the client, and there is the potential for feelings of powerlessness related to inability to control situation and being dependent on others. It is not likely that the nurse has been able to accurately assess sexual dysfunction. Not all clients with partial paralysis experience sexual dysfunction because this is dependent on the extent of spinal injury or nerve compression. Given that teaching is needed, it implies that there is a knowledge deficit.
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 seek emergency care if he or she develops a fever. - Hair loss should be expected when taking the medication. - The client should seek emergency help if nausea or vomiting occur. - 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.
Correct response: 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. Explanation: 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.
While assessing the patient at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the patients' cervical diskectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? A)Page the physician and report this sign of infection. B)Reinforce the dressing and reassess in 1 to 2 hours. C)Reposition the patient to prevent further hemorrhage. D)Inform the surgeon of the possibility of a dural leak.
Ans: D)Inform the surgeon of the possibility of a dural leak. Feedback: After a cervical diskectomy, the nurse will monitor the operative site and dressing covering this site. Serosanguineous drainage may indicate a dural leak. This constitutes a risk for meningitis, but is not a direct sign of infection. This should be reported to the surgeon, not just reinforced and observed.
The nurse is conducting a preoperative assessment of a client who is scheduled for surgical removal of a primary spinal tumor. What should the nurse include in the preoperative session? Select all that apply. - Ensuring privacy of client information from family members - Methods of pain control after surgery - Question about current bowel and bladder control - Adjusting to changes in daily activities - Preparing to transition to palliative care
Correct response: - Methods of pain control after surgery - Adjusting to changes in daily activities - Question about current bowel and bladder control Explanation: The objectives of preoperative care include recognition of neurologic changes through ongoing assessments, pain control, and the management of altered activities of daily living. The nurse assesses for weakness, muscle wasting, spasticity, sensory changes, bowel and bladder dysfunction, and potential respiratory problems, especially if a cervical tumor is present. The client is also evaluated for coagulation deficiencies. Postoperative pain management strategies are discussed with the client before surgery. Discussing the transition to palliative care would only be part of an individualized plan of care where the client is already aware the surgical procedure is life-prolonging rather that curative. It would be inappropriate to have this discussion with the client at this time. Family members should be encouraged to be part of the preoperative discussions, because they will be providing care and supporting the client after the surgery. Anticipatory guidance should be offered to the family as much as possible, because they will need to be prepared for changes in the client's ability to perform activities of daily living.
The nursing educator on a neurological unit is conducting a brief in-service on glial cell tumors. The educator tells the nurses that the most common type of glioma is an astrocytoma and that astrocytomas are graded from I to IV, indicating the degree of malignancy. What is the tumor's grading based on? - Cellular density, cell mitosis, and appearance - Size of cells, number of cells, and appearance - Cell mitosis, size of cells, and appearance - Cellular density, number of cells, and appearance
Correct response: Cellular density, cell mitosis, and appearance Explanation: The grading of a glioma is based on cellular density, cell mitosis, and appearance.
A 66-year-old woman with a recent history of headaches and agitation has been found to have a meningioma. The neurological nurse should understand that the symptoms of this woman's tumor are attributable to what pathophysiological process? - Invasion of brain tissue by the tumor - Impaired cerebrospinal fluid (CSF) synthesis - Compression of brain tissue - Intracerebral hemorrhage
Correct response: Compression of brain tissue Explanation: Manifestations of meningiomas depend on the area involved and are the result of compression rather than invasion of brain tissue. These tumors do not normally result in alterations in CSF production or bleeding.
What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply. - Take phenothiazine prior to meals - Increase high carbohydrate foods - Maintain a pureed diet - Use Relaxation techniques - Eliminate foods high in fat
Correct response: - Use Relaxation techniques - Take phenothiazine prior to meals Explanation: Talking to the client before meals will help to promote relaxation, and phenothiazines help to calm some clients. Eliminating foods high in fat, increasing carbohydrates, and pureeing food will not assist in relaxing muscles during choreiform movements. The nurse should wait for the client to chew and swallow, which can be a slow process.
Extensive diagnostic testing has resulted in a patient's diagnosis of a benign brain tumor. When providing care for this patient, the nurse should be cognizant of which of the following characteristics of benign brain tumors? - Benign brain tumors have no physiological effect but should be closely monitored. - Benign brain tumors can slowly grow into an area of vital brain function. - Benign brain tumors constitute a risk factor for possible metastasis. - Benign brain tumors typically become malignant within 1 to 2 years.
Correct response: Benign brain tumors can slowly grow into an area of vital brain function. Explanation: Benign tumors are slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. They do not necessarily develop to malignancy, and they are not primarily understood as simply a risk factor for further cancer.
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. - Place the client near the sounds and smells of meals being prepared. - Ensure that the client is free of pain for meals. - Plan meals for times when the client is rested. - Prepare the client for the insertion of a feeding tube. - Provide the client with foods that he likes.
Correct response: - 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. Explanation: 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.
Magnetic resonance imaging has confirmed a diagnosis of glioblastoma multiforme (GBM) in a 56-year-old male patient. The nurse who is planning this patient's care should prioritize which of the following nursing actions? - Liaising with community agencies to organize long-term rehabilitation - Choosing psychosocial interventions that are relevant to the patient's poor prognosis - Teaching the patient about the importance of healthy lifestyle in recovery from GBM - Teaching the patient about the pharmacological interventions relevant to his treatment
Correct response: Choosing psychosocial interventions that are relevant to the patient's poor prognosis Explanation: GBM is the most common and aggressive malignant brain tumor, and the overall prognosis is poor. Consequently, interventions should be chosen in light of this difficult reality. Pharmacological interventions are not the central treatments of GBM.
A patient's recent diagnostic workup has resulted in a diagnosis of a glioma, and a treatment plan is being promptly created by the multidisciplinary care team. The patient's oncologist has recommended chemotherapy, which is to be administered by the intrathecal route. The nurse should understand that the rationale for choosing this administration route involves which of the following considerations? - The patient will require weekly, rather than daily, drug administration. - The drug will bypass the blood-brain barrier. - The patient will not require IV access. - The drug can be administered on an outpatient basis.
Correct response: The drug will bypass the blood-brain barrier. Explanation: Chemotherapy that is given by intrathecal injection bypasses the blood-brain barrier. The rationale for choosing this route does not involve foregoing IV access, less frequent administration, or the possibility of outpatient administration.
11) ** 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 are all metastatic. - The prognosis is very poor. - They can affect vital functioning. - They do not require surgical removal.
Correct response: They can affect vital functioning. Explanation: Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.
The nurse is conducting a neurological assessment with a client who has increased intracranial pressure secondary to growth of brain tumor mass. What assessment tools can the nurse use to determine the client's neurological status? Select all that apply. - Beck Depression Inventory (BDI) - Glasgow coma scale (GCS) - Urinalysis - Chest auscultation - Mini mental status examination (MMSE)
Correct response: Glasgow coma scale (GCS) Mini mental status examination (MMSE) Explanation: Included within the neurological examination to determine deficits, the nurse should use the GCS, an assessment tool that can help identify the severity of brain injury for clients who have had surgery to remove a brain tumor. The MMSE can assist in evaluating the client's orientation to person, place and time. This tool can also assist the nurse is identifying changes to the client's cognitive functioning that may result from brain injury. A urinalysis would not provide any information on the client's neurological status. This test can provide information about the appearance, concentration and content of urine, but this is non-specific to issues related to neurological status. Chest auscultation is useful when conducting a respiratory assessment. The BDI is used to quantify an assessment of a client's mood and the severity of depression. This tool can be helpful when screening for mood disorders, but it does not provide any useful information about neurological status.
The community health nurse is preparing to conduct a home visit to a client in the community who was recently discharged from hospital after treatment of a metastatic brain lesion. What should the community health nurse plan to include within the time allotted for the home visit? Select all that apply. - Mental status examination - Skin integrity - Mobility - Use of pain medication - Cranial nerve functioning
Correct response: Mental status examination Skin integrity Mobility Use of pain medication Explanation: The community health nurse should ensure a comprehensive assessment is conducted to note any new deficits that may have developed since the client was discharged from the hospital. The mental status examination would uncover any neurological deficits that have developed. Assessment of skin integrity would uncover any possible impairments that could become portals for infection. This is especially important for clients who have bowel and/or bladder dysfunction. Changes in mobility could be related to pain management or new neurological deficits caused by compression of brain structures. It is always important to conduct a pain assessment to ensure client has adequate pain relief to engage in activities of daily living, rehabilitative activities and, overall, for the client's quality of life. Reports of increased pain and in different regions can be indicative of progression of the metastatic lesion. Cranial nerve function should be assessed during a clinic visit as the nurse may be limited in the community care setting (the client's home) with regards to the extent of a cranial nerve assessment that can be conducted.
The nurse is caring for a client who is postoperative from surgery for a brain tumor resection. The client has a visitor at the bedside who lowers the head of the bed below 30 degrees. The nurse assesses the client has decreased level of consciousness. What actions should the nurse take? Select all that apply. - Assess for presence of visual changes - Check for leaks on the surgical site dressing - Check the client's blood pressure - Review chart to check for high white blood cell count - Assess the client for headache
orrect response: Check the client's blood pressure Assess the client for headache Assess for presence of visual changes Explanation: The client is most likely developing increased intracranial pressure (ICP). With suspicion of ICP, the nurse should assess for ominous signs such as hypertension, bradycardia and respiratory depression. These are serious late signs of ICP and constitute an emergency. Headache is thought to be caused by the tumor's invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor. Thus, headaches are related to intracerebral edema and increasing ICP. Visual changes can result from ICP, which is referred to as papilledema. Papilledema results from edema on the optic nerve due to increased ICP. Leaking at the surgical site do not arise from increase ICP but can be a sign of infection or inflammation and warrant intervention. A high white blood cell count would indicate infection but would not necessarily be linked to ICP.
A 33-year-old man who is in healthy physical condition has been admitted to the emergency room with unilateral weakness and slurred speech. A computed tomography (CT) scan of the man's head reveals a hemorrhagic stroke despite the fact that the man is in good health with no history of hypertension, thromboembolism, or drug use. What type of brain tumor has the potential to cause this man's health problem? - Acoustic neuroma - Pituitary adenoma - Angioma - Meningioma
Correct response: Angioma Explanation: Because the walls of the blood vessels in angiomas are thin, affected patients are at risk for hemorrhagic stroke. In fact, cerebral hemorrhage in people younger than 40 years of age should suggest the possibility of an angioma.
A patient diagnosed with a pituitary adenoma has arrived on the oncology unit. Based upon the nurse's initial assessment, the patient is most likely to exhibit: - Headache - Decreased level of consciousness - Decreased intracranial pressure (ICP) - Restlessness
Correct response: Headache Explanation: Pressures from pituitary adenomas may cause headaches, visual dysfunction, and hypothalamic disorders. Restlessness is not a typical manifestation of pituitary adenomas. Pressure from pituitary adenomas would increase ICP, and these tumors would not usually cause decreased LOC.
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. - Respiratory infection - Aphasia - Incontinence - Fever - Paralysis
Correct response: Paralysis Incontinence Aphasia Explanation: 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.
A patient with a suspected brain tumor has been scheduled for a positron emission tomography (PET) scan. The nurse should explain to the patient that this test is being performed to assess: - The metabolic activity taking place in the patient's brain - The tissue characteristics of the patient's brain - The distribution patterns of cerebrospinal fluid (CSF) in the patient's central nervous system - The blood flow in the patient's brain
Correct response: The metabolic activity taking place in the patient's brain Explanation: PET, which measures the brain's activity rather than simply its structure, is useful in differentiating tumor from scar tissue or radiation necrosis. PET is not primarily used to assess blood flow, CSF flow, or structural characteristics.
A client with a malignant brain tumor comes to the clinic for a follow up. During the visit, the client asks the nurse, "Why am I so tired all the time?" When responding to the client, which information would the nurse include as possible causes? Select all that apply. - Tumor - Metastasis - Stress - Treatment being used - Effects of increased intracranial pressure
Correct response: Tumor Treatment being used Stress Explanation: Fatigue is a symptom experienced by clients with both malignant and nonmalignant brain tumors. Etiology of fatigue can be multifactorial. The tumor itself, surgery, medications, chemotherapy, and radiation may all contribute to increased fatigue. Clients may report a constant feeling of exhaustion, weakness, and lack of energy. It is also important to identify underlying conditions, such as stress, anxiety, and depression, which may play a role in fatigue. Metastasis and increased intracranial pressure are not usually associated with fatigue.
The nurse is planning the care of a patient who has been recently diagnosed with a cerebellar tumor. Due to the location of this patient's tumor, the nurse should implement measures to prevent what complication? A)Falls B)Audio hallucinations C)Respiratory depression D)Labile BP
Ans: A) Falls Feedback: A cerebellar tumor causes dizziness, an ataxic or staggering gait with a tendency to fall toward the side of the lesion, and marked muscle incoordination. Because of this, the patient faces a high risk of falls. Hallucinations and unstable vital signs are not closely associated with cerebellar tumors.
A nurse begins an assessment interview of a patient with a brain tumor. The patient describes her headaches. The nurse expects to hear specific terms that describe her symptoms. Which of the following best describe the symptoms of her headache? Select all that apply. - Is made worse with coughing and sudden movement - May improve with vomiting - Is intermittent and diminishes with rest - Is unrelenting - Occurs most frequently in the early morning
Correct response: - Occurs most frequently in the early morning - Is unrelenting - Is made worse with coughing and sudden movement - May improve with vomiting Explanation: Characteristic indicators of an intracerebral headache are a headache that occurs in the early morning; is made worse by coughing, straining, or sudden movement; and may improve with vomiting. It is described as deep, dull, and unrelenting.
Nurses are performing hourly neurological assessments of a patient who is postoperative day 1 following spinal surgery that was performed to treat spinal cord compression (SCC). The nurse's most recent assessment shows a marked reduction in motor and sensory function. How should the nurse best follow-up this assessment finding? A) Inform the care provider promptly about this sudden change. B) Reassess the patient in 15 minutes. C) Contact the anesthesiologist to discuss possible residual effects of anesthesia. D) Document these findings and have a colleague confirm the assessment.
A) Inform the care provider promptly about this sudden change. Sudden onset of neuro deficit is an ominous sign and may be due to vertebral collapse.
A patient has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The patient has just exhibited seizure activity for the first time. What is the nurse's priority response to this event? A)Identify the triggers that precipitated the seizure. B)Implement precautions to ensure the patient's safety. C)Teach the patient's family about the relationship between brain tumors and seizure activity. D)Ensure that the patient is housed in a private room.
Ans: B)Implement precautions to ensure the patient's safety. Feedback: Patients with seizures are carefully monitored and protected from injury. Patient safety is a priority over health education, even though this is appropriate and necessary. Specific triggers may or may not be evident; identifying these is not the highest priority. A private room is preferable, but not absolutely necessary.
A middle-aged patient has undergone emergency neurosurgery for the treatment of spinal cord compression (SCC) that was detected by magnetic resonance imaging (MRI). Which of the following signs and symptoms is considered an early sign of spinal compression? - Intermittent claudication - Urinary incontinence - Personality changes - Muscle spasticity
Correct response: Urinary incontinence Explanation: Early symptoms associated with SCC include back pain, and bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation). Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Personality changes and intermittent claudication are not associated with SCC.
