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A family member of a client diagnosed with a brain tumor states that he is feeling distraught and guilty for not encouraging the client to seek medical evaluation earlier. Which information should the nurse incorporate when formulating a response to the family member's statement?
- A. A brain tumor presents with few sights/symptoms.
- B. It is true that brain tumors are easily recognizable.
- C. Brain tumors are never detected until very late in their course.
- D. The signs/symptoms of a brain tumor may be easily attributed to another cause.
Correct Answer: D
Rationale: Signs and symptoms of a brain tumor vary depending on location, and they may easily be attributed to another cause. Symptoms include headache, vomiting, visual disturbances, and changes in intellectual abilities or personality. Seizures occur in some clients. These symptoms can be easily attributed to other causes. The family requires support to assist them during the normal grieving process. Options 1, 2, and 3 are inaccurate statements.
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The nurse is preparing a plan of care for a client demonstrating mania. Which interventions should be included in the plan of care?
- A. Place the client in seclusion.
- B. Ignore any client complaints.
- C. Use a firm and calm approach.
- D. Use short and concise explanations and statements.
- E. Remain neutral and avoid power struggles and value judgments.
- F. Firmly redirect energy into more appropriate and constructive channels.
Correct Answer: C,D,E,F
Rationale: A client with mania will be extremely restless, disorganized, and chaotic. Grandiose plans are extremely out of touch with reality, and judgment is poor. Interventions for the client in acute mania include using a firm and calm approach to provide structure and control, using short and concise explanations or statements because of the client's short attention span, remaining neutral and avoiding power struggles and value judgments, being consistent in approach and expectations and having frequent staff meetings to plan consistent approaches and to set agreed-on limits to avoid manipulation by the client, hearing and acting on legitimate client complaints, and redirecting energy into more appropriate and constructive channels.
A client who is receiving total parenteral nutrition (TPN) tells the nurse, 'I'm not sure that I want to receive an infusion of lipids because it could make me obese.' Which initial action should the nurse take?
- A. Inquire how illness affects the client's self-concept.
- B. Ask the provider to discuss the benefits of intralipids.
- C. State that intralipids supply essential fatty acids for life.
- D. Explain how intralipids replace dietary sources of lipids.
Correct Answer: A
Rationale: A client who receives TPN is at risk for developing an essential fatty acid deficiency; however, this client's comment requires more than a simple informational response initially. Thus, the nurse responds with option 1 to assist the client with self-expression and to deal with aspects of illness and treatment. Option 2 delays client self-expression and devalues the client's feelings. Options 3 and 4 provide information only.
A client with a diagnosis of schizophrenia is experiencing visual hallucinations. The nurse plans care based on the determination that this symptom is related to an alteration in brain function in which lobe of the cerebrum?
- A. 1
- B. 2
- C. 3
- D. 4
Correct Answer: D
Rationale: Visual hallucinations indicate an alteration in brain function in the cerebrum. The occipital lobe is located in the back of the head and is primarily responsible for seeing and receiving information and is responsible for visual hallucinations. The temporal lobe lies beneath the skull on both sides of the brain and is primarily responsible for hearing and receiving information via the ears. Symptoms indicating an alteration of function in the temporal lobe include auditory hallucinations, sensory aphasia, alterations in memory, and altered emotional responses. The frontal lobe is located in the anterior or front area of the brain and is primarily responsible for motor functions, higher thought processes such as decision making, intellectual insight and judgment, and expression of emotion. Symptoms indicating an alteration of function in the frontal lobe include changes in affect, alteration in language production, alteration in motor function, impulsive behavior, and impaired decision making. The parietal lobe lies beneath the skull at the back and top of the head and is primarily responsible for association and sensory perception. Symptoms indicating an alteration of function in the parietal lobe include alterations in sensory perceptions, difficulty with time concepts and calculating numbers, alteration in personal hygiene, and poor attention span.
The nurse manager of the psychiatric unit plans the biweekly, unit-wide interdisciplinary team case conference focused on one particular client. Which client is most important for the manager to select for discussion?
- A. A client who was admitted after a second serious suicide attempt and refuses to talk.
- B. A client toward whom the staff have sharply conflicting attitudes and actions.
- C. A client who experiences hallucinations, takes possessions from other clients, and paces continually.
- D. A client, well known and well liked by staff, whose diagnostic testing reveals a brain tumor.
Correct Answer: A
Rationale: A client with a recent serious suicide attempt who refuses to talk is at high risk for self-harm and requires urgent interdisciplinary discussion to coordinate safety and treatment plans. Other cases, while significant, are less immediately life-threatening.
A client who is scheduled for an abdominal peritoneoscopy states to the home care nurse, 'The surgeon told me to restrict food and liquids for at least 8 hours before this procedure and to use a Fleet enema 4 hours before entering the hospital. Do people ever get into trouble after this procedure?' Which is the most appropriate therapeutic response the nurse should make to the client?
- A. Any invasive procedure brings risk with it. You need to report any shoulder pain immediately.'
- B. You seem to understand the preparation very well. Are you having any concerns about the procedure?'
- C. Trouble? There is never any trouble with this procedure. That's why the surgeon will use local anesthesia.'
- D. There are relatively few problems, especially if you are having local anesthesia, but vaginal bleeding should be reported immediately.'
Correct Answer: B
Rationale: Abdominal peritoneoscopy is performed to directly visualize the liver, gallbladder, spleen, and stomach after the insufflation of nitrous oxide. During the procedure, a rigid laparoscope is inserted through a small incision in the abdomen. A microscope in the endoscope allows for the visualization of the organs and provides a way to collect a specimen for biopsy or remove small tumors. The appropriate response is the one that facilitates the expression of the client's feelings. Option 1 may increase the client's anxiety. In option 3, the nurse states that no problems are associated with this procedure; this is closed-ended and is incorrect. Although option 4 contains accurate information, the word immediately can increase the client's anxiety.