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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?
- A. Metastasis
- B. Risk for stroke
- C. Emotional and personality changes
- D. Pathologic bone fractures
Correct Answer: C
Rationale: Huntington's disease causes significant emotional and personality changes due to neurologic degeneration. It is not malignant, nor does it increase stroke or fracture risk.
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A patient diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the patients 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 patients pre-existing health status
- D. Whether the tumor is primary or the result of metastasis
Correct Answer: B
Rationale: Pituitary adenoma effects depend on the hormones it secretes, impacting bodily functions. Respiration type, health status, or tumor origin are less determinative.
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 nurses priority response to this event?
- A. Identify the triggers that precipitated the seizure.
- B. Implement precautions to ensure the patients safety.
- C. Teach the patients family about the relationship between brain tumors and seizure activity.
- D. Ensure that the patient is housed in a private room.
Correct Answer: B
Rationale: Safety during a seizure is the priority to prevent injury. Education, trigger identification, and room assignment are secondary actions.
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 nurses most appropriate action?
- A. Promoting the patients 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
Correct Answer: B
Rationale: Untreated brain metastases lead to a rapid decline, making palliative care the priority to manage symptoms and improve quality of life. Promoting function or withholding information is less appropriate.
The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patients ADLs, what goal should the nurse prioritize?
- A. Promoting the patients recovery from the disease
- B. Maximizing the patients level of function
- C. Ensuring the patients adherence to treatment
- D. Fostering the familys participation in care
Correct Answer: B
Rationale: Muscular dystrophy is incurable, so maximizing function through ADLs is the priority. Family participation and adherence support this goal but are secondary.
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?
- A. Chronic confusion
- B. Impaired urinary elimination
- C. Impaired verbal communication
- D. Bowel incontinence
Correct Answer: C
Rationale: ALS causes progressive speech impairment, making impaired verbal communication a primary concern. Cognitive function, bladder, and bowel control are typically preserved.