Ch 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders Flashcards Preview

Care II - Exam 4: Oncology & Renal > Ch 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders > Flashcards

Flashcards in Ch 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders Deck (40)
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1

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.

2

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
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.

3

The nurse is writing a care plan for a patient 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 patient, the nurse should include what intervention?
A) The patient will receive antianxiety medications every 4 hours.
B) The patient's family will be instructed on planning the patient's care.
C) The patient will be encouraged to verbalize concerns related to the disease and its treatment.
D) The patient will begin intensive therapy with the goal of distraction.

Ans: C
Feedback:
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 and administering medications will not allow the patient to gain control over anxiety. Delegating planning to the family will not help the patient gain a sense of control and autonomy.

4

A patient with suspected Parkinson's disease is initially being assessed by the nurse.
When is the best time to assess for the presence of a tremor?
A) When the patient is resting
B) When the patient is ambulating
C) When the patient is preparing his or her meal tray to eat
D) When the patient is participating in occupational therapy

Ans: A
Feedback:
The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the patient is not performing deliberate actions.

5

The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect of Sinemet would the nurse assesses this patient?
A) Pruritus
B) Dyskinesia
C) Lactose intolerance
D) Diarrhea

Ans: B Feedback:
Within 5 to 10 years of taking levodopa, most patients 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.

6

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patient's ADLs, what goal should the nurse prioritize?
A) Promoting the patient's recovery from the disease
B) Maximizing the patient's level of function
C) Ensuring the patient's adherence to treatment
D) Fostering the family's participation in care

Ans: B
Feedback:
Priority for the care of the child with muscular dystrophy is the need to maximize the patient'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.

7

A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to diagnose
spinal cord compression from a tumor, the nurse will most likely prepare the patient for
what test?
A) Anterior-posterior x-ray
B) Ultrasound
C) Lumbar puncture
D) MRI

Ans: D Feedback:
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.

8

A patient with Parkinson's disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patient'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
Feedback:
A semisolid diet with thick liquids is easier for a patient with swallowing difficulties to
consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the patient's nutritional status. The patient's status does not warrant TPN.

9

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
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.

10

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
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.

11

A patient has just been diagnosed with Parkinson's disease and the nurse is planning the patient's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patient's family?
A) Risk for infection
B) Impaired spontaneous ventilation
C) Unilateral neglect
D) Risk for injury

Ans: D
Feedback:
Individuals with Parkinson's 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's disease does not directly constitute a risk for infection or impaired respiration.

12

The nurse is caring for a patient with Huntington disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the patient's plan of care?
A) Firmly redirect the patient's head when feeding.
B) Administer phenothiazines after each meal as ordered.
C) Encourage the patient to keep his or her feeding area clean.
D) Apply deep, gentle pressure around the patient's mouth to aid swallowing.

Ans: D
Feedback:
Nursing interventions for a patient who has inadequate nutritional intake should include
the following: Apply deep gentle pressure around the patient's mouth to assist with swallowing, and administer phenothiazines prior to the patient's meal as ordered. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the patient during feeding are uncontrollable choreiform movements and should not be interrupted.

13

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
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.

14

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
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.

15

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.

Ans: D
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.

16

The nurse in an extended care facility is planning the daily activities of a patient with postpolio syndrome. The nurse recognizes the patient 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
Feedback:
Important activities for patients with postpolio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening.

17

A patient newly diagnosed with a cervical disk herniation is receiving health education from the clinic nurse. What conservative management measures should the nurse teach the patient 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
Feedback:
Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic
relief from pain. The patient may need to wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disk herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.

18

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 to patient in what position?
A) In the high Fowler's position
B) In a flat side-lying position
C) In the Trendelenberg position
D) In the reverse Trendelenberg position

Ans: B
Feedback:
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's position, Trendelenberg position, and reverse Trendelenberg position are inappropriate for this patient because they would result in increased pain and complications.

19

A patient with Huntington disease has just been admitted to a long-term care facility.
The charge nurse is creating a care plan for this patient. Nutritional management for a
patient with Huntington disease should be informed by what principle?
A) The patient is likely to have an increased appetite.
B) The patient is likely to required enzyme supplements.
C) The patient will likely require a clear liquid diet.
D) The patient will benefit from a low-protein diet.

Ans: A
Feedback:
Due to the continuous involuntary movements, patients will have a ravenous appetite.
Despite this ravenous appetite, patients usually become emaciated and exhausted. As the disease progresses, patients experience difficulty in swallowing and thin liquids should be avoided. Protein will not be limited with this disease. Enzyme supplements are not normally required.

20

A patient with amyotrophic lateral sclerosis (ALS) is being visited by the home health nurse who is creating a care plan. What nursing diagnosis is most likely for a patient with this condition?
A) Chronic confusion
B) Impaired urinary elimination
C) Impaired verbal communication
D) Bowel incontinence

Ans: C
Feedback:
Impaired communication is an appropriate nursing diagnosis; the voice in patients with
ALS assumes a nasal sound and articulation becomes so disrupted that speech is unintelligible. Intellectual function is marginally impaired in patients 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.

21

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

Ans: C, D, E
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.

22

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?
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
Feedback:
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.

23

A gerontologic nurse is advocating for diagnostic testing of an 81-year-old patient 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 patient over age 75.

Ans: A
Feedback:
In older adult patients, 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 patients. Treatment options are not dependent primarily on age.

24

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
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.

25

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
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.

26

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
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.

27

A patient has been admitted to the neurologic ICU with a diagnosis of a brain tumor.
The patient 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
Feedback:
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. Deep tendon reflexes, abdominal girth, and
hearing acuity are less commonly affected by brain tumors and do not affect the risk for
aspiration.

28

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
Feedback:
Cachexia is a wasting syndrome of weight loss, muscle atrophy, fatigue, weakness, and
significant loss of appetite. Consequently, nutritional assessment is paramount.

29

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
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.

30

An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson's disease?
A) Lately he seems to move far more slowly than he ever has in the past.
B) He often complains that his joints are terribly stiff when he wakes up in the
morning.
C) He's forgotten the names of some people that we've known for years.
D) He's losing weight even though he has a ravenous appetite.

Ans: A
Feedback:
Parkinson's disease is characterized by bradykinesia. It does not manifest as memory
loss, increased appetite, or joint stiffness.