Chapter 65: Management of Patients with Oncologic or Degenerative Neurologic Disorders Flashcards
- A nurse is assessing a client 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
Rationale: An acoustic neuroma is a tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance. The client 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 client with brain metastases is considering life expectancy after the
client’s most recent meeting with her oncologist. Based on the fact that the client is not
receiving treatment for the brain metastases, what is the nurse’s most appropriate
action?
A. Promoting the client’s functional status and ADLs
B. Ensuring that the client receives adequate palliative care
C. Ensuring that the family does not tell the client that the condition is terminal
D. Promoting adherence to the prescribed medication regimen
ANS: B
Rationale: Clients 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 client. Adherence to medications such as analgesics is important, but palliative care is a high priority.
- The nurse is writing a care plan for a client with brain metastases. The nurse decides
that an appropriate nursing diagnosis is “anxiety related to lack of control over the health
circumstances.” In establishing this plan of care for the client, the nurse should include
which intervention?
A. Antianxiety medications every 4 hours
B. Family instruction on planning the client’s care
C. Encouragement to verbalize concerns related to the disease and its treatment
D. Intensive therapy with the goal of distraction
ANS: C
Rationale: Clients 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 and administering medications will not allow the client to gain control over anxiety. Delegating planning to the family will not help the client gain a sense of control and autonomy.
- The clinic nurse caring for a client with Parkinson disease notes that the client has been
taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect
should the nurse assess this client?
A. Pruritus
B. Dyskinesia
C. Lactose intolerance
D. Diarrhea
ANS: B
Rationale: Within 5 to 10 years of taking levodopa, most clients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another
potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.
- The nurse is caring for a boy who has muscular dystrophy. When planning assistance
with the client’s ADLs, what goal should the nurse prioritize?
A. Promoting the client’s recovery from the disease
B. Maximizing the client’s level of function
C. Ensuring the client’s adherence to treatment
D. Fostering the family’s participation in care
ANS: B
Rationale: Priority for the care of the child with muscular dystrophy is the need to maximize the client’s level of function. Family participation is also important, but should
be guided by this goal. Adherence is not a central goal, even though it is highly beneficial, and the disease is not curable.
- A 37-year-old client is brought to the clinic by the spouse because the client is
experiencing loss of motor function and sensation. The health care provider suspects the
client has a spinal cord tumor and hospitalizes the client for diagnostic testing. In light of
the need to rule out spinal cord compression from a tumor, the nurse will most likely
prepare the client for what test?
A. Anterior-posterior x-ray
B. Ultrasound
C. Lumbar puncture
D. MRI
ANS: D
Rationale: 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 client with Parkinson disease is undergoing a swallowing assessment because the
client has recently developed adventitious lung sounds. The client’s nutritional needs
should be met by what method?
A. Total parenteral nutrition (TPN)
B. Provision of a low-residue diet
C. Semisolid food with thick liquids
D. Minced foods and a fluid restriction
ANS: C
Rationale: A semisolid diet with thick liquids is easier for a client with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the client’s nutritional status. The client’s status does not warrant TPN until all other options have been ruled out.
- A client, diagnosed with cancer of the lung, has just been told the cancer has
metastasized to the brain. What change in health status would the nurse attribute to the
client’s metastatic brain disease?
A. Chronic pain
B. Respiratory distress
C. Fixed pupils
D. Personality changes
ANS: D
Rationale: 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.
- A client has just been diagnosed with Parkinson disease and the nurse is planning the
client’s subsequent care for the home setting. What nursing diagnosis should the nurse
address when educating the client’s family?
A. Risk for infection
B. Impaired spontaneous ventilation
C. Unilateral neglect
D. Risk for injury
ANS: D
Rationale: Individuals with Parkinson disease face a significant risk for injury related to the effects of dyskinesia. Unilateral neglect is not characteristic of the disease, which
affects both sides of the body. Parkinson disease does not directly constitute a risk for infection or impaired respiration.
- The nurse is caring for a client with Huntington disease who has been admitted to the
hospital for treatment of malnutrition. What independent nursing action should be
implemented in the client’s plan of care?
A. Firmly redirect the client’s head when feeding.
B. Administer phenothiazines after each meal as prescribed.
C. Encourage the client to keep his or her feeding area clean.
D. Apply deep, gentle pressure around the client’s mouth to aid swallowing.
ANS: D
Rationale: Nursing interventions for a client who has inadequate nutritional intake should include the following: apply deep gentle pressure around the client’s mouth to assist with swallowing, and administer phenothiazines prior to the client’s meal as prescribed. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the client during feeding are uncontrollable choreiform movements and should not be interrupted.
- A client has been admitted to the neurologic unit for the treatment of a newly
diagnosed brain tumor. The client 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 client’s safety.
C. Teach the client’s family about the relationship between brain tumors and
seizure activity.
D. Ensure that the client is housed in a private room.
ANS: B
Rationale: Clients with seizures are carefully monitored and protected from injury. Client safety is a priority over health education, even though this is appropriate and necessary.
Specific triggers may or may not be evident; identifying these are not the highest priority. A private room is preferable, but not absolutely necessary.
- A client diagnosed with a pituitary adenoma has arrived on the neurologic unit. When
planning the client’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 client’s pre-existing health status
D. Whether the tumor is primary or the result of metastasis
ANS: B
Rationale: 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 client’s health status or whether the tumor is primary versus secondary. Anaerobic and aerobic respiration are not relevant.
- A client with a metastatic brain tumor of the frontal lobe experiences a generalized
seizure for the first time. The nurse should prepare for what action?
A. Intubation
B. STAT computed tomography (CT) health care provider
C. A STAT MRI
D. Administration of anticonvulsants
ANS: D
Rationale: Seizure activity necessitates anticonvulsants. In most cases, the development of seizure activity does not require immediate diagnostic imaging. Intubation is
unnecessary except in cases of respiratory failure.
- The nurse in an extended care facility is planning the daily activities of a client with
post-polio syndrome. The nurse recognizes the client will best benefit from physical
therapy when it is scheduled at what time?
A. Immediately after meals
B. In the morning
C. Before bedtime
D. In the early evening
ANS: B
Rationale: Important activities for clients with post-polio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening.
- A client newly diagnosed with a cervical disk herniation is receiving health education
from the clinic nurse. What conservative management measures should the nurse teach
the client to implement?
A. Perform active ROM exercises three times daily.
B. Sleep on a firm mattress.
C. Apply cool compresses to the back of the neck daily.
D. Wear the cervical collar for at least 2 hours at a time.
ANS: B
Rationale: Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic relief from pain. The client may need to wear a cervical collar 24 hours a day
during the acute phase of pain from a cervical disc herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.
- A client has just returned to the unit from the PACU after surgery for a tumor within
the spine. The client reports pain. When positioning the client for comfort and to reduce
injury to the surgical site, the nurse will position to client in what position?
A. In the high Fowler position
B. In a flat side-lying position
C. In the Trendelenburg position
D. In the reverse Trendelenburg position
ANS: B
Rationale: 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 Fowler position, Trendelenburg position, and reverse Trendelenburg position are inappropriate for this client because they would result in
increased pain and complications.
- A client with amyotrophic lateral sclerosis (ALS) is being visited by the home health
nurse who is creating a care plan. Which of the following nursing diagnoses is most likely
for a client with this condition?
A. Chronic confusion
B. Impaired urinary elimination
C. Impaired verbal communication
D. Bowel incontinence
ANS: C
Rationale: Impaired communication is an appropriate nursing diagnosis; the voice in clients with ALS assumes a nasal sound and articulation becomes so disrupted that
speech is unintelligible. Intellectual function is marginally impaired in clients with late ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that
control muscles of the rectum and urinary bladder are not affected.
- The nurse is caring for a client with a brain tumor who is experiencing symptoms due
to compression and infiltration of normal tissue. The pathophysiologic changes that result
can cause what manifestations? Select all that apply.
A. Intracranial hemorrhage
B. Infection of cerebrospinal fluid
C. Increased ICP
D. Focal neurologic signs
E. Altered pituitary function
ANS: C, D, E
Rationale: 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 client newly diagnosed with a primary brain tumor. The client
asks the nurse where the tumor came from. What would be the nurse’s best response?
A. “Your tumor originated from somewhere outside the CNS.”
B. “Your tumor likely started out in one of your glands.”
C. “Your tumor originated from cells within your brain itself.”
D. “Your tumor is from nerve tissue somewhere in your body.”
ANS: C
Rationale: 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 client’s tumor is a pituitary tumor or a neuroma.
- A gerontologic nurse is advocating for diagnostic testing of an 81-year-old client who
is experiencing personality changes. The nurse is aware of what factor that is known to
affect the diagnosis and treatment of brain tumors in older adults?
A. The effects of brain tumors are often attributed to the cognitive effects of aging.
B. Brain tumors in older adults do not normally produce focal effects.
C. Older adults typically have numerous benign brain tumors by the eighth decade
of life.
D. Brain tumors cannot normally be treated in clients over age 75.
ANS: A
Rationale: In older adult clients, early signs and symptoms of intracranial tumors can be easily overlooked or incorrectly attributed to cognitive and neurologic changes associated
with normal aging. Brain tumors are not normally benign and they produce focal effects in all clients. Treatment options are not dependent primarily on age.
- A client 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 client’s vomiting is most consistent with a brain tumor?
A. The client’s vomiting is accompanied by epistaxis.
B. The client’s vomiting does not relieve his nausea.
C. The client’s vomiting is unrelated to food intake.
D. The client’s emesis is blood-tinged.
ANS: C
Rationale: 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 client’s nausea.
- A male client presents at the free clinic with reports of erectile dysfunction. 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
Rationale: Male clients 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.
- The nurse is planning the care of a client who has been recently diagnosed with a
cerebellar tumor. Due to the location of this client’s tumor, the nurse should implement
measures to prevent what complication?
A. Falls
B. Audio hallucinations
C. Respiratory depression
D. Labile BP
ANS: A
Rationale: 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 client faces a high risk of falls. Hallucinations and unstable vital signs are not closely associated with cerebellar tumors.
- A client has been admitted to the neurologic ICU with a diagnosis of a brain tumor.
The client is scheduled to have a tumor resection/removal in the morning. Which of the
following assessment parameters should the nurse include in the initial assessment?
A. Gag reflex
B. Deep tendon reflexes
C. Abdominal girth
D. Hearing acuity
ANS: A
Rationale: Preoperatively, the gag reflex and ability to swallow are evaluated. In clients with diminished gag response, care includes teaching the client to direct food and fluids toward the unaffected side, having the client sit upright to eat, offering a semisoft diet, and having suction readily available. Deep tendon reflexes, abdominal girth, and hearing acuity are less commonly affected by brain tumors and do not affect the risk for aspiration.
