Chapter 65: Management of Patients with Oncologic or Degenera- tive Neurologic
Disorders
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition
MULTIPLE CHOICE
1. 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.
PTS: 1 REF: p. 2115
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
2. 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.
PTS: 1 REF: p. 2118
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
3. 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.
PTS: 1 REF: p. 2121 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
4. 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.
PTS: 1 REF: p. 2124
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
5. 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.
PTS: 1 REF: p. 2132
NAT: Client Needs: Physiological Integrity: Basic Care and Comfort
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
, 6. 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.
PTS: 1 REF: p. 2116
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
7. 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.
PTS: 1 REF: p. 2127
NAT: Client Needs: Physiological Integrity: Basic Care and Comfort
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
8. 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.
PTS: 1 REF: p. 2118
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 65: Management of Clients With Oncologic or Degenerative Neurologic Disorders
