Ch 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders Flashcards
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
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
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.
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.
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.
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
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.
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.
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
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.
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
A) Anterior-posterior x-ray
C) Lumbar puncture
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.
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
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.
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.
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.
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
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 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
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.
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.
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.
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
D) Ensure that the patient is housed in a private room.
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 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
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 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.
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 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
Important activities for patients with postpolio syndrome should be planned for the morning, as fatigue often increases in the afternoon and evening.