Chapter 66

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?

Loss of hearing, tinnitus, and vertigo

Loss of vision, change in mental status, and hyperthermia

Loss of hearing, increased sodium retention, and hypertension

Loss of vision, headache, and tachycardia

Loss of hearing, tinnitus, and vertigo

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?

Promoting the patient's functional status and ADLs

Ensuring that the patient receives adequate palliative care

Ensuring that the family does not tell the patient that her condition is terminal

Promoting adherence to the prescribed medication regimen

Ensuring that the patient receives adequate palliative care

The nurse is writing a care plan for a patient with brain metastases. The nurse decides that an appropriate nursing diagnosis is anxicty related to lack of control over the health circumstances." In establishing this plan of care for the patient, the nurse should include what intervention?

The patient will receive antianxiety medications every 4 hours.

The patient's family will be instructed on planning the patient's care.

The patient will be encouraged to verbalize concerns related to the discase and its treatment.

The patient will begin intensive therapy with the goal of distraction.

The patient will be encouraged to verbalize concerns related to the discase and its treatment.

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?

When the patient is resting

When the patient is ambulating

When the patient is preparing his or her meal tray to eat

When the patient is participating in occupational therapy

When the patient is resting

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?

Pruritus

Dyskinesia

Lactose intolerance

Diarrhea

Dyskinesia

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?

Promoting the patient's recovery from the disease

Maximizing the patient's level of function

Ensuring the patient's adherence to treatment

Fostering the family's participation in care

Maximizing the patient's level of function

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?

Anterior-posterior x-ray

Ultrasound

Lumbar puncture

MRI

MRI

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?

Total parenteral nutrition (TPN)

Provision of a low-residue diet

Semisolid food with thick liquids

Minced foods and a fluid restriction

Semisolid food with thick liquids

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?

Page the physician and report this sign of infection.

Reinforce the dressing and reassess in 1 to 2 hours.

Reposition the patient to prevent further hemorrhage.

Inform the surgeon of the possibility of a dural leak.

Inform the surgeon of the possibility of a dural leak.

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?

Chronic pain

Respiratory distress

Fixed pupils

Personality changes

Personality changes

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?

Risk for infection

Impaired spontaneous ventilation

Unilateral neglect

Risk for injury

Risk for injury

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?

Firmly redirect the patient's head when feeding.

Administer phenothiazines after each meal as ordered.

Encourage the patient to keep his or her feeding area clean.

Apply deep, gentle pressure around the patient's mouth to aid swallowing.

Apply deep, gentle pressure around the patient's mouth to aid swallowing.

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?

Identify the triggers that precipitated the seizure.

Implement precautions to ensure the patient's safety.

Teach the patient's family about the relationship between brain tumors and seizure activity.

Ensure that the patient is housed in a private room.

Implement precautions to ensure the patient's safety.

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?

Whether the tumor utilizes aerobic or anaerobic respiration

The specific hormones secreted by the tumor

The patient's pre-existing health status

Whether the tumor is primary or the result of metastasis

The specific hormones secreted by the tumor

A male patient with a metastatic brain tumor is having a generalized seizure and begins vomiting. What should the nurse do first?

Perform oral suctioning.

Page the physician.

Insert a tongue depressor into the patient's mouth.

Turn the patient on his side.

Turn the patient on his side.

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?

Immediately after meals

In the morning

Before bedtime

In the early evening

In the morning

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?

Perform active ROM exercises three times daily.

Sleep on a firm mattress.

Apply cool compresses to the back of the neck daily.

Wear the cervical collar for at least 2 hours at a time.

Sleep on a firm mattress.

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?

In the high Fowler's position

In a flat side-lying position

In the Trendelenberg position

In the reverse Trendelenberg position

In a flat side-lying position

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?

The patient is likely to have an increased appetite.

The patient is likely to required enzyme supplements.

The patient will likely require a clear liquid diet.

The patient will benefit from a low-protein diet.

The patient is likely to have an increased appetite.

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?

Chronic confusion

Impaired urinary elimination

Impaired verbal communication

Bowel incontinence

Impaired verbal communication

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.

Intracranial hemorrhage

Infection of cerebrospinal fluid

Increased ICP

Focal neurologic signs

Altered pituitary function

Increased ICP

Focal neurologic signs

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 originated from somewhere outside the CNS."

"Your tumor likely started out in one of your glands."

"Your tumor originated from cells within your brain itself."

"Your tumor is from nerve tissue somewhere in your body."

"Your tumor originated from cells within your brain itself."

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?

The effects of brain tumors are often attributed to the cognitive effects of aging.

Brain tumors in older adults do not normally produce focal effects.

Older adults typically have numerous benign brain tumors by the eighth decade of life.

Brain tumors cannot normally be treated in patient over age 75.

The effects of brain tumors are often attributed to the cognitive effects of aging.

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?

The patient's vomiting is accompanied by epistaxis.

The patient's vomiting does not relieve his nausea.

The patient's vomiting is unrelated to food intake.

The patient's emesis is blood-tinged.

The patient's vomiting is unrelated to food intake.

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?

Prolactinoma

Angioma

Glioma

Adrenocorticotropic hormone (ACTH)-producing adenoma

Prolactinoma

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?

Falls

Audio hallucinations

Respiratory depression

Labile BP

Falls

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?

Gag reflex

Deep tendon reflexes

Abdominal girth

Hearing acuity

Gag reflex

A patient with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize?

Assessment of peripheral nervous function

Assessment of cranial nerve function

Assessment of nutritional status

Assessment of respiratory status

Assessment of nutritional status

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.

Pain control

Management of treatment complications

Interpretation of diagnostic tests

Assistance with self-care

Administration of treatments

Pain control

Management of treatment complications

Assistance with self-care

Administration of treatments

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?

"Lately he seems to move far more slowly than he ever has in the past."

"He often complains that his joints are terribly stiff when he wakes up in the morning."

"He's forgotten the names of some people that we've known for years."

"He's losing weight even though he has a ravenous appetite."

"Lately he seems to move far more slowly than he ever has in the past."

A patient, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease?

Metastasis

Risk for stroke

Emotional and personality changes

Pathologic bone fractures

Emotional and personality changes

A patient who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patient's medication regimen?

The patient is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident.

Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment.

The patient's temporary improvement in status is likely unrelated to levodopa-carbidopa.

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goal?

Promoting effective communication

Controlling diarrhea

Preventing cognitive decline

Managing choreiform movements

Promoting effective communication

The nurse is caring for a patient diagnosed with Parkinson's disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination?

Use of a bedpan

Use of a raised toilet seat

Sitting quietly on the toilet every 2 hours

Following the outlined bowel program

Use of a raised toilet seat

A patient with Parkinson's disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond?

"It's important to drink plenty of fluids while you're taking laxatives."

"Make sure that you supplement your laxatives with a nutritious diet."

"Let's explore other options, because laxatives can have side effects and create dependency."

"You should ideally be using herbal remedies rather than medications to promote

bowel function."

"Let's explore other options, because laxatives can have side effects and create dependency."

A family member of a patient diagnosed with Huntington disease calls you at the clinic. She is requesting help from the Huntington's Disease Society of America. What kind of help can this patient and family receive from this organization? Select all that apply.

Information about this disease

Referrals

Public education

Individual assessments

Appraisals of research studies

Information about this disease

Referrals

Public education

A patient with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the patient best make known his wishes for care as his disease progresses?

Prepare an advance directive.

Designate a most responsible physician (MRP) early in the course of the disease.

Collaborate with representatives from the Amyotrophic Lateral Sclerosis

Association.

Ensure that witnesses are present when he provides instruction.

Prepare an advance directive.

The nurse is caring for a patient who is scheduled for a cervical discectomy the following day. During health education, the patient should be made aware of what potential complications?

Vertebral fracture

Hematoma at the surgical site

Scoliosis

Renal trauma

Hematoma at the surgical site

The nurse responds to the call light of a patient who has had a cervical diskectomy earlier in the day. The patient states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action?

Palpate the surgical site.

Remove the dressing to assess the surgical site.

Call the surgeon to report the patient's pain.

Administer a dose of an NSAID.

Call the surgeon to report the patient's pain.

A nurse is planning discharge education for a patient who underwent a cervical diskectomy. What strategies would the nurse assess that would aid in planning discharge teaching?

Care of the cervical collar

Technique for performing neck ROM exercises

Home assessment of ABGs

Techniques for restoring nerve function

Care of the cervical collar