Oncologic & Degenerative Neurologic Disorders – Comprehensive Bullet-Point Notes
Brain Tumors
General Classification
Benign (non-cancerous)
Slow growing, less likely to spread (e.g., meningiomas)
Still compress adjacent tissue → serious neurologic deficits.
Malignant (cancerous)
Fast growing, invasive; may infiltrate adjacent CNS structures.
Can be primary (originate inside CNS) or secondary (metastatic from other organs).
Determinants of Classification
Location, histology, primary vs. secondary origin.
Primary tumors DO NOT metastasize outside CNS.
Major Primary Tumor Types
Gliomas: astrocytoma, oligodendroglioma, glioblastoma.
Meningioma (usually benign yet potentially invasive).
Acoustic neuroma (vestibular schwannoma) → hearing loss, tinnitus, vertigo (CN VIII).
Pituitary adenoma → hormonal syndromes (Cushing, acromegaly).
Angioma = vascular malformation (neither primary nor secondary) ↑ risk hemorrhage.
Secondary (Metastatic) Tumors
Common primaries: lung, breast, kidney, melanoma.
Can seed cerebrum, cerebellum, brainstem.
Clinical Manifestations (depend on size, site, compression)
Local/global neurologic signs.
↑ ICP: headache, vomiting, papilledema, hypertension + bradycardia + bradypnea (Cushing triad).
LOC changes: restlessness, drowsiness, purposeless movements.
Ocular signs: pupillary changes, EOM palsy.
Seizures, visual loss, sensory deficits, motor weakness/paralysis.
Tumor-specific: pituitary → endocrine; acoustic → hearing loss; cerebellar → ataxia/dizziness.
Diagnostic Work-up
Neuro exam.
Imaging: CT (rapid), MRI (gold standard), PET (metabolic), stereotactic CT/MRI maps.
EEG (if seizures), CSF cytology, definitive biopsy.
Medical / Surgical Management
Choice guided by type, site, accessibility.
Surgery
Craniotomy (open) for resection/decompression.
Transsphenoidal (pituitary region).
Stereotactic biopsy or radiosurgery (precise 3-D targeting).
Radiation therapy: cornerstone adjunct/primary when unresectable; damages tumor DNA; potential tissue deformation.
Chemotherapy: systemic or local wafers; pre-treat with anti-emetics; alopecia common.
Pharmacology
Analgesics for pain.
Dexamethasone ↓ cerebral edema.
Phenytoin prophylaxis for seizures.
Nursing Assessment / Priorities
Baseline neuro status; monitor progression.
Assess pain, airway, skin, nutrition, bowel/bladder, family coping.
Encourage advance directives early while A&O.
Patient/Family Goals & Interventions
Compensate for self-care deficits; optimize nutrition; decrease anxiety; support family; prevent complications.
Promote independence, cognitive stimulation, shared decision making, expression of fears.
Refer to PT/OT, social work, hospice as indicated.
Oral hygiene before meals; timing & environment of meals; preferred foods; supplements; daily weights & intake records.
Spinal Cord Tumors
Anatomic Classification
Intramedullary = within cord parenchyma.
Extramedullary (intradural or extradural) outside cord tissue.
Key Manifestations
Local/radiating pain worse at night or movement.
Progressive weakness → loss motor function, reflexes.
Sensory loss, paresthesias below lesion.
Treatment Principles
Depends on benign vs. malignant + level.
Surgical resection if accessible; high cervical lesions risk tetraplegia, lower → paraplegia.
Dexamethasone + radiation to reduce cord compression when inoperable.
Parkinson’s Disease (PD)
Essentials
Slow, progressive movement disorder; degeneration of substantia nigra dopaminergic neurons.
Dopamine ↓ → relative ↑ acetylcholine → motor hyper-excitability.
Typical onset >40 yrs; 60{,}000 new US cases/yr; 50\% higher incidence in men.
Pathophysiology Cascade
Neuronal death in substantia nigra.
Dopamine store depletion.
Nigrostriatal pathway degeneration.
Imbalance dopamine (inhibitory) vs. ACh (excitatory) in corpus striatum.
Extrapyramidal motor tract impairment.
Four Cardinal Motor Signs
Tremor at rest (“pill-rolling”); worse with fatigue, ↓ with sleep/purposeful action.
Rigidity (cog-wheel); difficulty initiating movement; jerky passive ROM.
Bradykinesia/akinesia (slowness or inability to start movement).
Postural instability → stooped posture, propulsive/shuffling gait, turning “en bloc”.
Other Motor/Autonomic/Neuropsych Symptoms
Mask-like facies, reduced blink.
Micrographia, monotonous speech.
Dysphagia, drooling.
Sweating, flushing, orthostatic hypotension, gastric/urinary retention.
Restlessness, pacing.
Psychiatric: depression, anxiety, hallucinations, later dementia.
Assessment Focus
Quality of speech, facial expression, swallow, tremor severity, rigidity, gait, mental status, fall risk, med response cycle.
Nursing Goals & Interventions
Improve mobility: daily exercise, PT, rocking to initiate motion, assistive devices, proper footwear, raised seats.
Maintain ADL independence; environmental mods; OT.
Bowel regimen, adequate nutrition (small frequent meals, thickened liquids PRN, swallow eval).
Communication aids; support groups; realistic goal setting.
Medical Management
Pharmacology: Levodopa + Carbidopa (Sinemet) most effective; other dopaminergics, anticholinergics, MAO-B inhibitors.
Surgical: stereotactic thalamotomy, pallidotomy, deep-brain stimulation; experimental neural transplantation.
Huntington’s Disease (HD) / Huntington’s Chorea
Overview
Autosomal dominant; onset 25$–$35\,(\pm17) yrs; inexorably progressive choreiform movements + dementia.
Pathology: premature neuronal death in striatum & cortex → motor, cognitive, psychiatric decline.
Motor Findings
Chorea (rapid, jerky, purposeless movements), imbalance, falls → helmets advised.
Rigidity later; dysarthria, dysphagia, weight loss, aspiration risk.
Cognitive & Psychiatric Spectrum
Executive dysfunction, memory loss, attention deficits, perseveration, poor judgment, lack of insight.
Depression, anxiety, irritability, aggression, disinhibition, OCD traits, psychosis.
Complications
Constipation, incontinence, malnutrition, dehydration, social isolation, suicidal ideation.
Diagnostics
CT/MRI: brain atrophy (≈30\% weight loss).
Definitive genetic test (CAG repeat); counsel before conception.
Management (No cure)
Symptom control & support.
Meds: antipsychotics (haloperidol, olanzapine), antidepressants (fluoxetine), benzodiazepines, mood stabilizers, botulinum for dystonia.
Nutrition: ↑ calories, thickened liquids, small pieces/purees, avoid dairy (↑ mucus), feeding tube PRN.
Physical activity with safety (weights, padded environment), social engagement, caregiver respite.
Amyotrophic Lateral Sclerosis (ALS) – “Lou Gehrig Disease”
Pathologic Triad
Amyotrophy = muscle atrophy (LMN loss).
Lateral column sclerosis (UMN tract scarring).
Progressive loss motor neurons in spinal cord anterior horn & brainstem.
Clinical Picture
Progressive limb weakness → flaccid quadriplegia, atrophy, fasciculations, cramps.
Mixed UMN signs: spasticity, brisk reflexes; LMN signs: atrophy, fasciculations.
Bulbar involvement: dysarthria, nasal speech, tongue atrophy, dysphagia.
Respiratory muscle failure → ventilation dependence; major mortality cause.
Fatigue with talking, lack of coordination.
Proposed Etiologies
Viral triggers, autoimmune attack, excess glutamate excitotoxicity.
Priority Problems & Nursing Measures
Respiratory failure / pneumonia → airway clearance, BiPAP/vent support, aspiration precautions.
Swallow dysfunction → speech therapist, texture mods, PEG tube discussion.
Musculoskeletal decline → PT, ROM, pressure injury prevention.
Advance directives; psychosocial support; symptom-based care (riluzole, edaravone, muscle relaxants, antispasmodics).
Muscular Dystrophy
Incurable inherited myopathies; progressive skeletal muscle wasting; Duchenne = X-linked most common.
Shared traits: variable weakness, ↑ serum CK.
Degenerative Disc Disease (DDD)
Major contributor to low-back pain; discs degenerate with age/trauma → radiculopathy.
Conservative Rx first (rest, NSAIDs); surgery if severe.
Post-Polio Syndrome
Appears 30$–$40 yrs post infection; new weakness, fatigue, pain; etiology unclear (overuse of surviving neurons).
No definitive therapy; supportive.
Cervical Discectomy
Indications: herniated cervical disc, spinal stenosis, radiculopathy, myelopathy after failed conservative care.
Pre-Op Assessment
Onset, location, radiation of pain; what worsens/relieves.
Neuro deficits: paresthesia, weakness, limited ROM, bilateral vs. unilateral signs.
Palpate cervical spine for spasm/tenderness; measure ROM.
Review comorbidities (osteoporosis, DM), previous surgeries; patient education on procedure & recovery.
Potential Complications
Hematoma → cord/airway compression (neck swelling, stridor, acute neuro loss) → emergent evacuation.
Persistent/recurrent pain due to incomplete decompression, scar, adjacent segment disease.
Post-Op Goals & Nursing Care
Relieve pain: analgesics, NSAIDs, muscle relaxants.
Improve mobility: early PT, neck brace as ordered, activity restrictions (no lifting/twisting).
Monitor for dysphagia, hoarseness, infection, neuro deficits.
Educate on home care, wound signs, when to seek help.
Key Cross-Cutting Themes & Ethical Points
Early advance directives critical in progressive neuro disorders (brain tumors, ALS) while cognition intact (decisions on G-tube, CPR).
Interdisciplinary collaboration (neurosurgery, oncology, PT/OT, speech, social work, hospice) maximizes quality of life.
Family coping & caregiver burden addressed via counseling, support groups, respite services.
Fall-prevention strategies essential in PD, HD, spinal tumors (environmental mods, assistive devices, footwear).
Question 1: Brain Tumor - Reduction of Risk Potential
A client with a newly diagnosed brain tumor develops a severe headache, projectile vomiting, and bradycardia. The nurse immediately recognizes these symptoms as indicative of:
A. Seizure activity
B. Cerebellar dysfunction
C. Increased intracranial pressure (ICP)
D. Pituitary adenoma
Correct Answer: C
Rationale: Headache, projectile vomiting, bradycardia, and hypertension (Cushing triad, though not all elements are listed here, headache and vomiting are key initial signs) are classic signs of increased intracranial pressure (ICP). Early recognition and intervention are crucial to prevent further neurological damage.
Question 2: Parkinson's Disease - Basic Care and Comfort / Safety
A nurse is planning care for a client with Parkinson's disease experiencing bradykinesia and postural instability. Which intervention is most appropriate to include in the plan of care to enhance the client's mobility and safety?
A. Encourage the client to wear rubber-soled shoes to prevent falls.
B. Advise the client to take large, deliberate steps when walking.
C. Instruct the client to restrict fluids to prevent urinary retention.
D. Recommend maintaining a supine position for prolonged periods.
Correct Answer: A
Rationale: Clients with Parkinson's disease often have a shuffling gait and are at high risk for falls. Rubber-soled shoes can increase friction and make it more difficult to lift their feet, increasing the risk of tripping. Smooth-soled shoes are preferred. Rocking to initiate motion and assistive devices are helpful. Large, deliberate steps are incorrect; a propulsive/shuffling gait is common. Fluid restriction is inappropriate and can lead to dehydration. Prolonged supine position is not indicated and can lead to complications like skin breakdown.
Question 3: Amyotrophic Lateral Sclerosis (ALS) - Reduction of Risk Potential / Physiological Adaptation
A client with Amyotrophic Lateral Sclerosis (ALS) is experiencing increasing difficulty swallowing and frequent episodes of coughing during meals. What is the nurse's priority intervention?
A. Encourage the client to eat quickly to minimize fatigue during meals.
B. Administer a muscle relaxant immediately to improve swallowing.
C. Consult with a speech therapist for a swallow evaluation and texture modification.
D. Prepare the client for immediate mechanical ventilation.
Correct Answer: C
Rationale: Dysphagia is a common and serious complication of ALS, leading to aspiration risk. A speech therapist can assess the severity of dysphagia and recommend appropriate food texture modifications and swallowing techniques to ensure safe nutrition and prevent aspiration pneumonia. Options A and B are incorrect and potentially harmful. While respiratory failure is a major cause of mortality in ALS, it's not the immediate priority for swallowing difficulties unless acute respiratory distress is present; a swallow evaluation is the first step.
Question 4: Huntington's Disease - Physiological Integrity / Basic Care and Comfort
The nurse is caring for a client with Huntington's disease who exhibits chorea and significant weight loss. Which nursing intervention is most appropriate to address the client's nutritional needs?
A. Provide a low-calorie, low-protein diet to reduce jerky movements.
B. Offer large, infrequent meals with standard consistency foods.
C. Encourage a high-calorie diet with thickened liquids and pureed foods.
D. Administer antipsychotic medications before meals to suppress appetite.
Correct Answer: C
Rationale: Clients with Huntington's disease experience chorea (rapid, jerky movements) which increases their caloric expenditure, leading to weight loss. Dysphagia is also common. Therefore, a high-calorie diet with thickened liquids and small, frequent pureed meals is crucial to ensure adequate nutrition and minimize aspiration risk. Antipsychotics may be used to manage chorea, but not to suppress appetite. Low-calorie diets are inappropriate given the weight loss.
Question 5: Cervical Discectomy - Reduction of Risk Potential
Following an anterior cervical discectomy, a client develops neck swelling, stridor, and acute neurological deficits. The nurse should anticipate which emergent intervention?
A. Administration of high-dose corticosteroids.
B. Emergent evacuation of a hematoma.
C. Application of a cervical collar.
D. Placement of a nasogastric tube.
Correct Answer: B
Rationale: Neck swelling, stridor (indicating airway obstruction), and acute neurological deficits post-cervical discectomy are hallmark signs of a post-operative hematoma compressing the spinal cord and/or airway. This is a medical emergency requiring immediate surgical evacuation. While corticosteroids might be used for edema, they won't address the compression from a hematoma. A cervical collar is standard post-op care but won't resolve acute compression. A nasogastric tube is irrelevant to emergent airway/neurological compromise.
Question 6: Spinal Cord Tumors - Physiological Adaptation
A client with a newly diagnosed spinal cord tumor reports progressive weakness, paresthesias below the lesion, and pain that is worse at night. The nurse understands these symptoms are primarily due to:
A. Autonomic dysreflexia.
B. Increased cerebrospinal fluid production.
C. Compression of spinal nerves and tracts.
D. Muscular dystrophy progression.
Correct Answer: C
Rationale: Spinal cord tumors exert pressure on the spinal cord itself and/or the spinal nerves originating from it. This compression leads to symptoms such as localized or radiating pain, progressive weakness, loss of motor function, changes in reflexes, and sensory loss or paresthesias below the level of the lesion. These symptoms are often exacerbated by movement or at night.
Question 7: Key Cross-Cutting Themes - Psychosocial Integrity / Management of Care
The nurse is caring for a client with a progressive neurological disorder like ALS. The most appropriate time for the nurse to initiate a discussion about advance directives is when the client:
A. Is experiencing severe respiratory distress.
B. Is alert and oriented with intact cognitive function.
C. Has expressed feelings of hopelessness and depression.
D. Is approaching the final stages of the disease.
Correct Answer: B
Rationale: Early discussion of advance directives while the client is alert and oriented with intact cognitive function ensures that their wishes regarding end-of-life care (e.g., G-tube, CPR, ventilation) are clearly understood and documented. Waiting until the client is in severe distress or has advanced cognitive impairment compromises their ability to make informed decisions. While depression should be addressed, it's not the ideal time for first discussing advance directives.
Question 8: Brain Tumors - Pharmacological and Parenteral Therapies
A client with a brain tumor is prescribed Dexamethasone. The nurse understands that the primary purpose of this medication for brain tumors is to:
A. Directly kill tumor cells.
B. Prevent seizures.
C. Reduce cerebral edema.
D. Relieve pain.
Correct Answer: C
Rationale: Dexamethasone is a corticosteroid commonly used in clients with brain tumors to reduce cerebral edema (swelling) around the tumor. This helps to alleviate symptoms caused by increased intracranial pressure. Anti-emetics are given for nausea, phenytoin for seizures, and analgesics for pain, but Dexamethasone's primary role here is to manage edema.
Question 9: Parkinson's Disease - Pharmacological and Parenteral Therapies
When teaching a client with Parkinson's disease about Levodopa/Carbidopa (Sinemet), the nurse should include which important instruction?
A. Take the medication only when tremors are severe.
B. Expect immediate and complete relief of all symptoms.
C. Report any sudden inability to move ('on-off' phenomenon).
D. Increase protein intake to enhance medication absorption.
Correct Answer: C
Rationale: Levodopa/Carbidopa is the most effective medication for Parkinson's disease, but clients can experience motor fluctuations, including sudden periods of akinesia or profound bradykinesia known as the 'on-off' phenomenon. Reporting this allows the healthcare provider to adjust the dosing regimen. The medication is typically taken regularly, not just for severe tremors. It provides symptom management, not complete relief. High-protein diets can interfere with Levodopa absorption and should be consumed strategically, often separate from medication administration, making D incorrect.
Question 10: Huntington's Disease - Psychosocial Integrity
In caring for a client with Huntington's disease, the nurse recognizes the high risk for psychosocial challenges. Which nursing intervention is most crucial to address these challenges?
A. Avoiding all discussion about the client's progressive decline to prevent distress.
B. Limiting social interactions to prevent embarrassment from involuntary movements.
C. Facilitating access to support groups and counseling for the client and family.
D. Reinforcing that the client's aggressive outbursts are intentional and controllable.
Correct Answer: C
Rationale: Huntington's disease is inexorably progressive and affects motor, cognitive, and psychiatric functions, leading to significant psychosocial distress for both the client and family/caregivers. Facilitating access to support groups, counseling, and respite services is crucial to help them cope with the disease progression, manage caregiver burden, and address issues like depression, anxiety, and social isolation. Avoiding discussions, limiting social interactions, or misinterpreting behaviors like aggressive outbursts are detrimental to psychosocial well-being.
Question 11: Brain Tumors - Physiological Adaptation
A client with a newly diagnosed pituitary adenoma is admitted. The nurse should primarily monitor for which clinical manifestation indicating a common complication?
A. Progressive weakness in extremities
B. Hormonal imbalances like Cushing's syndrome
C. Significant weight loss and night sweats
D. Unilateral hearing loss and vertigo
Correct Answer: B
Rationale: Pituitary adenomas are known to cause hormonal syndromes such as Cushing's syndrome and acromegaly due to their location and function within the endocrine system. Progressive weakness is more general, weight loss/night sweats are more associated with malignancy, and unilateral hearing loss/vertigo points to an acoustic neuroma.
Question 12: Parkinson's Disease - Basic Care and Comfort
The nurse is teaching a client with Parkinson's disease about managing dysphagia. Which instruction is LEAST appropriate?
A. Take small, frequent meals throughout the day.
B. Thicken liquids to a nectar or honey consistency.
C. Tilt the head backward when swallowing to facilitate food passage.
D. Sit upright during meals and remain so for 3030 minutes afterward.
Correct Answer: C
Rationale: Tilting the head backward (hyperextension) during swallowing can actually widen the airway and increase the risk of aspiration in dysphagia, especially for clients with neurological deficits affecting swallowing. Instead, tilting the head forward (chin tuck) is often recommended to protect the airway. Small, frequent meals, thickened liquids, and maintaining an upright position are appropriate interventions.
Question 13: Amyotrophic Lateral Sclerosis (ALS) - Reduction of Risk Potential
For a client in the advanced stages of Amyotrophic Lateral Sclerosis (ALS), which potential complication represents the most critical immediate threat to life?
A. Severe muscle cramps and fasciculations
B. Deep vein thrombosis due to immobility
C. Respiratory muscle failure
D. Malnutrition from dysphagia
Correct Answer: C
Rationale: Respiratory muscle failure due to the progressive loss of motor neurons to the diaphragm and intercostal muscles is the major cause of mortality in clients with ALS. While other complications like cramps, DVT, and malnutrition are significant, respiratory compromise poses the most immediate life threat.
Question 14: Huntington's Disease - Health Promotion and Maintenance
A 28-year-old client with a family history of Huntington's Disease asks about genetic testing before planning a family. What is the most important information the nurse should provide regarding the genetic test?
A. The test results will determine the exact age of symptom onset.
B. Genetic testing can definitively diagnose if one will develop the disease.
C. A positive test means symptoms can be prevented if lifestyle changes are made.
D. The test primarily determines if the client is a carrier of the disease gene.
Correct Answer: B
Rationale: Huntington's disease is an autosomal dominant disorder, and a definitive genetic test for the CAG repeat expansion can determine if an individual will develop the disease. It does not predict the exact age of onset, nor can symptoms be prevented by lifestyle changes. It determines if one has the gene (and thus will develop the disease), not just if they are a carrier, as it is a dominant disorder.
Question 15: Cervical Discectomy - Physiological Adaptation
Which specific finding, post-anterior cervical discectomy, should alert the nurse to potential damage to the recurrent laryngeal nerve?
A. Sudden onset of stridor
B. Difficulty swallowing (dysphagia)
C. Hoarseness or changes in voice
D. Increased neck pain with movement
Correct Answer: C
Rationale: The recurrent laryngeal nerve is located close to the surgical field during an anterior cervical discectomy. Damage or irritation to this nerve can result in hoarseness or vocal cord paralysis, manifesting as changes in voice. Stridor suggests airway compression, dysphagia can be from swelling or hematoma, and increased neck pain is a general post-op symptom.
Question 16: Spinal Cord Tumors - Basic Care and Comfort
When assessing a client with a suspected spinal cord tumor, the nurse should specifically inquire about pain that is:
A. Relieved by rest and mild analgesics.
B. Sharp and localized to the extremity.
C. Worse at night and with movement.
D. Accompanied by muscle spasms around the lesion.
Correct Answer: C
Rationale: A key manifestation of spinal cord tumors is local or radiating pain that is often worse at night or with movement. This is due to the tumor's pressure on the spinal nerves and cord. Pain relieved by rest/analgesics is less indicative of a tumor. Localized sharp pain can be musculoskeletal. While spasms can occur, the worsening at night/movement is a more classic distinguishing feature.
Question 17: Muscular Dystrophy - Health Promotion and Maintenance
When educating the parents of a child newly diagnosed with Duchenne Muscular Dystrophy, the nurse explains that a shared characteristic across most muscular dystrophies is:
A. Recovery of muscle strength with appropriate therapy.
B. A viral etiology requiring antiviral medication.
C. Progressive skeletal muscle wasting.
D. Normal serum creatine kinase (CK) levels.
Correct Answer: C
Rationale: Muscular dystrophies are incurable inherited myopathies characterized by progressive skeletal muscle wasting. They do not involve recovery of muscle strength, are not caused by viruses, and are typically associated with elevated serum CK levels due to muscle damage.
Question 18: Degenerative Disc Disease (DDD) - Management of Care
A client is diagnosed with Degenerative Disc Disease (DDD) and is experiencing low-back pain. The nurse anticipates that the initial treatment approach will likely focus on:
A. Immediate surgical intervention (discectomy).
B. Long-term opioid pain management.
C. Conservative management including rest and NSAIDs.
D. Spinal fusion to stabilize the affected segment.
Correct Answer: C
Rationale: For Degenerative Disc Disease, conservative treatment is almost always the first line of management unless there are severe or progressive neurological deficits. This typically includes rest, NSAIDs, physical therapy, and other non-surgical interventions. Surgery is usually reserved for cases that fail conservative treatment or have significant neurological compromise. Long-term opioids are generally avoided, and fusion is a more invasive surgical option.
Question 19: Parkinson's Disease - Psychosocial Integrity
A client with advanced Parkinson's disease is experiencing increasing social isolation due to difficulty communicating and embarrassment from drooling and tremors. What is the most appropriate nursing intervention?
A. Advise the family to limit visitors to reduce the client's stress.
B. Encourage the client to spend more time alone to practice speech.
C. Refer the client and family to a support group and speech therapy.
D. Reassure the client that these symptoms will eventually resolve.
Correct Answer: C
Rationale: Social isolation is a significant psychosocial challenge for clients with Parkinson's disease. Referring to support groups can provide emotional support and strategies for coping, while speech therapy can help manage communication difficulties and drooling. Limiting visitors or encouraging isolation would worsen the problem. Reassuring that symptoms will resolve is false and provides false hope.
Question 20: Key Cross-Cutting Themes - Management of Care
The nurse is collaborating with an interdisciplinary team for a client with a progressive neurological disorder. What is the primary benefit of this collaborative approach?
A. It ensures that the nurse is solely responsible for all aspects of care.
B. It minimizes the need for client and family involvement in decision-making.
C. It maximizes the client's quality of life through comprehensive care.
D. It focuses primarily on acute medical interventions.
Correct Answer: C
Rationale: Interdisciplinary collaboration (involving neurosurgery, oncology, PT/OT, speech, social work, hospice) is crucial for progressive neurological disorders. Its primary benefit is to maximize the client's quality of life by providing comprehensive, holistic care that addresses physical, cognitive, psychosocial, and functional needs. It does not place sole responsibility on the nurse, should involve the client/family, and extends beyond acute interventions.
Question 21: ALS - Health Promotion and Maintenance
A client newly diagnosed with ALS asks about medications to slow the progression of the disease. The nurse should explain that which medication is commonly used for this purpose?
A. Phenytoin
B. Dexamethasone
C. Riluzole
D. Haloperidol
Correct Answer: C
Rationale: Riluzole and Edaravone are medications approved to slow the progression of ALS, primarily by reducing glutamate excitotoxicity. Phenytoin is an anticonvulsant, Dexamethasone is a corticosteroid for reducing cerebral edema, and Haloperidol is an antipsychotic.
Question 22: Huntington's Disease - Physiological Integrity
When assisting a client with Huntington's disease with meals, which nursing intervention is most critical due to the client's characteristic motor movements?
A. Providing a low-sodium diet.
B. Encouraging rapid eating to finish quickly.
C. Supervising during meals and noting aspiration risk.
D. Administering a large bolus of fluids with each meal.
Correct Answer: C
Rationale: Clients with Huntington's disease exhibit chorea, which includes rapid, jerky, purposeless movements, and also develop dysphagia. These factors significantly increase the risk of aspiration. Therefore, close supervision during meals and assessing for aspiration signs are critical. Low-sodium diets are not specifically indicated, rapid eating increases aspiration risk, and large fluid boluses can also increase aspiration risk.
Question 23: Parkinson's Disease - Pharmacological and Parenteral Therapies
A client on Levodopa/Carbidopa (Sinemet) for Parkinson's disease reports experiencing nausea and dizziness, especially when standing up quickly. The nurse should advise the client to:
A. Discontinue the medication immediately.
B. Take the medication on an empty stomach.
C. Report this to the healthcare provider and change positions slowly.
D. Increase the dosage of the medication.
Correct Answer: C
Rationale: Nausea and orthostatic hypotension (dizziness upon standing) are common side effects of Levodopa/Carbidopa. Clients should be taught to change positions slowly to minimize dizziness and report persistent or severe side effects to their healthcare provider for potential dosage adjustment or management strategies. Discontinuing abruptly is dangerous, taking on an empty stomach might worsen nausea, and increasing the dosage could worsen side effects.
Question 24: Brain Tumors - Nursing Assessment / Priorities
The nurse is performing a neurological assessment on a client with a known brain tumor. The earliest and most sensitive indicator of deteriorating neurological status is:
A. Changes in pupillary response.
B. Decreased level of consciousness (LOC).
C. Onset of projectile vomiting.
D. Alterations in motor strength.
Correct Answer: B
Rationale: Changes in level of consciousness, such as restlessness, drowsiness, or subtle alterations in mental status, are often the earliest and most sensitive indicators of increasing intracranial pressure and neurological deterioration. While pupillary changes, vomiting, and motor weakness are important signs, LOC changes typically precede them.
Question 25: Cervical Discectomy - Post-Op Nursing Care
After an anterior cervical discectomy, the nurse observes that the client is frequently clearing their throat and appears uncomfortable when swallowing saliva. The priority action for the nurse is to:
A. Offer ice chips to soothe the throat.
B. Administer PRN analgesics for pain.
C. Assess for signs of dysphagia and airway obstruction.
D. Document the finding and reassess in 4 hours.
Correct Answer: C
Rationale: Throat clearing and discomfort with swallowing post-cervical discectomy can indicate pharyngeal edema, hematoma formation, or recurrent laryngeal nerve irritation, all of which pose a risk to airway patency and safe swallowing. The nurse's priority is to immediately assess for signs of dysphagia (e.g., coughing, choking, gurgling voice) and, critically, signs of airway obstruction (e.g., stridor, respiratory distress) rather than just offering comfort measures or delayed reassessment.
Question 26: Post-Polio Syndrome - Health Promotion and Maintenance
A client diagnosed with Post-Polio Syndrome (PPS) reports new onset of muscle weakness and severe fatigue, 35 years after initial polio infection. The nurse should explain that the etiology of PPS is thought to be related to:
A. A re-activation of the polio virus.
B. Overuse of surviving motor neurons.
C. A new autoimmune attack on the nervous system.
D. Progressive degeneration of the spinal cord.
Correct Answer: B
Rationale: The exact etiology of Post-Polio Syndrome is unclear, but a leading theory postulates that it results from the overuse and subsequent degeneration of the surviving motor neurons that compensated for the original viral damage. It is not a re-activation of the virus, a new autoimmune attack specifically, nor generally described as progressive spinal cord degeneration in the broader sense that ALS is.
Question 27: Key Cross-Cutting Themes - Ethical Points
A nurse is discussing advance directives with a client recently diagnosed with a progressive neurodegenerative disease. The client becomes tearful and states, "I don't want to talk about dying." What is the most appropriate nursing response?
A. "Okay, we can talk about this another time when you're ready."
B. "It's important to do this now while you're able to make your own decisions."
C. "This isn't about dying, it's about making your wishes known for your future care."
D. "I understand this is difficult, but it's required for your care plan."
Correct Answer: C
Rationale: While respecting the client's feelings, it is important to gently reframe the conversation about advance directives. It's not solely about "dying" but about empowering the client to maintain autonomy over their future medical care. Options A defers indefinitely, B might be too blunt, and D is coercive. Reframing helps the client understand the purpose without directly denying their feelings.
Question 28: Parkinson's Disease - Assessment Focus
When assessing the characteristic gait of a client with Parkinson's disease, the nurse would expect to observe:
A. A wide-based, unsteady gait with irregular steps.
B. A high-stepping gait with foot drop.
C. A slow, shuffling gait with reduced arm swing.
D. A scissors gait where legs cross at the knees.
Correct Answer: C
Rationale: Clients with Parkinson's disease typically exhibit a propulsive or shuffling gait, with small, rapid steps (festination) and often reduced or absent arm swing. They also experience postural instability. The other options describe gait abnormalities seen in different neurological conditions.
Question 29: ALS - Nursing Measures
To prevent the most common cause of mortality in clients with Amyotrophic Lateral Sclerosis (ALS), the nurse should prioritize interventions aimed at:
A. Maintaining adequate hydration.
B. Preventing pressure injuries.
C. Ensuring effective airway clearance and respiratory support.
D. Managing muscle spasticity and cramps.
Correct Answer: C
Rationale: As noted in the concept of "Priority Problems & Nursing Measures" for ALS, respiratory muscle failure and pneumonia are the major causes of mortality. Therefore, ensuring effective airway clearance, monitoring respiratory status, and providing BiPAP/vent support are critical nursing priorities to prevent this fatal outcome.
Question 30: Huntington's Disease - Complications
A nurse is planning care for a client with Huntington's disease who is at risk for complications due to chorea and dysphagia. Which intervention best addresses two potential complications simultaneously?
A. Administering laxatives daily to prevent constipation.
B. Providing a high-calorie, pureed diet to address weight loss and aspiration risk.
C. Encouraging large fluid intake to prevent dehydration.
D. Implementing fall precautions with padded furniture due to imbalance.
Correct Answer: B
Rationale: Chorea increases caloric expenditure (leading to weight loss), and dysphagia increases aspiration risk. A high-calorie, pureed diet directly addresses both the nutritional deficit and the aspiration risk, thus tackling two significant complications simultaneously. While other options address individual complications, this one is dual-purpose and highly impactful.