MedSurg Ch. 70

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient?

Coumadin

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

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

A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma:

Originated within the brain tissue.

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

laminectomy

Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply.

• Bradykinesia • Tremor • Rigidity • Postural instability

Which of the following diseases is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain?

Parkinson's disease

The nurse is aware that, when assessing a patient for symptoms of a brain tumor, the symptom most frequently found is:

Simple to generalized seizures.

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 132 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

600

Which of the following terms is used to describe rapid, jerky, involuntary, and purposeless movements of the extremities?

Chorea

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level?

Dopamine

A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.

10

What nursing intervention will best assist the patient with chorea?

Monitor the patient on bed rest.

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.

• Dysphagia • Choking • Constipation

The patient with a brain tumor may be at increased risk for aspiration. The most important nursing intervention includes which of the following.

Evaluation of gag reflex and ability to swallow

A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively?

Help the client assume a more comfortable position.

Which of the following is the only known risk factor for brain tumors?

Ionizing radiation

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan?

Keeping the head in a neutral position

Which of the following medications is the most effect agent in the treatment of Parkinson's disease (PD)?

Levodopa (Larodopa)

The nurse teaches the patient that corticosteroids will be used to treat his brain tumor for which reason?

Reduce cerebral edema

A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate?

"You sound a bit overwhelmed. Tell me more about what's happening."

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

750

A patient with a cervical disc herniation in the acute phase is complaining of numbness and tingling of his arms. What are the priority interventions for the nurse to perform? Select all that apply.

• Have the patient wear a cervical collar daily. • Provide NSAID therapy. During the acute phase, the nurse should assist the patient in wearing his or her cervical collar daily. The administration of NSAIDs will assist the patient to reduce pain and tissue swelling. Isometric exercises should not be started during the acute phase, and weight lifting exercises are never appropriate. Strengthening the legs will not assist in this condition and exercise should be very limited during the acute phase of this condition.

A patient is admitted complaining of low back pain. What will best assist the nurse in determining if the pain is related to a herniated lumbar disc?

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

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk?

Pain radiating down the posterior thigh

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?

Ineffective airway clearance

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern?

Adopt a diet with moderate fiber intake.

Which of the following is a late symptom of spinal cord compression?

Paralysis

The nurse teaches the patient with which disorder his or her disease is due to decreased levels of dopamine in the basal ganglia of the brain?

Parkinson's disease

A 17-year-old adolescent with a history of muscular dystrophy is admitted with aspiration pneumonia. The nurse asks the parents if the client has an advance directive. Which response by the parents leads the nurse to believe that the parents don't understand the severity of the client's medical condition?

"He is only 17. He doesn't need an advance directive."

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

Dyskinesia

Which of the following is an anticholinergic agent used to control tremor and rigidity in Parkinson's disease?

Benztropine Mesylate (Cogentin)

A nurse is providing care to a client with Parkinson's disease. The nurse understands the the client's signs and symptoms are related to a depletion of which of the following?

Dopamine

The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care?

Encourage the client to massage the facial and neck muscles before eating.

Which of the following provides the best outcome for most tumor types?

Surgery

Which of the following is a rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles?

Chorea

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

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

A nurse knows that a patient exhibiting seizurelike movements localized to one side of the body most likely has what type of tumor?

A motor cortex tumor 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.

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

Severe lower back pain