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The client is diagnosed with a metastatic brain tumor, and radiation therapy is scheduled. The client asks the nurse, 'Why not try chemotherapy first? It has helped my other tumors.' The nurse’s response is based on which scientific rationale?
- A. Chemotherapy is only used as a last resort in caring for clients with brain tumors.
- B. The blood-brain barrier prevents medications from reaching the brain.
- C. Radiation therapy will have fewer side effects than chemotherapy.
- D. Metastatic tumors become resistant to chemotherapy and it becomes useless.
Correct Answer: B
Rationale: The blood-brain barrier (B) limits chemotherapy penetration into the brain, making radiation more effective for brain metastases. Chemotherapy is used in some cases (A), radiation side effects vary (C), and resistance (D) is not universally true.
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The client, who had a stroke, follows the nurse’s instructions without problems, but an attempt to verbally respond to the nurse’s question was garbled. The nurse should identify that the client has which type of aphasia?
- A. Receptive aphasia
- B. Global aphasia
- C. Expressive aphasia
- D. Anomic aphasia
Correct Answer: C
Rationale: With receptive aphasia (Wernicke’s aphasia or fluent aphasia) the client would hear the voice but would be unable to comprehend the meaning of the message. Global aphasia is a combination of receptive and expressive aphasia. The client would have difficulty speaking and understanding words and would not be able to read or write. The nurse should identify that the client has expressive aphasia (Broca’s aphasia or non-fluent aphasia). The client is able to comprehend and responds appropriately. The client may attempt to speak but has difficulty communicating with the correct words. With anomic aphasia, the client would have word-finding difficulties; this client does not verbalize.
Which assessment data would make the nurse suspect that the client has amyotrophic lateral sclerosis?
- A. History of a cold or gastrointestinal upset in the last month.
- B. Complaints of double vision and drooping eyelids.
- C. Fatigue, progressive muscle weakness, and twitching.
- D. Loss of sensation below the level of the umbilicus.
Correct Answer: C
Rationale: ALS presents with fatigue, progressive muscle weakness, and fasciculations (twitching, C). Recent illness (A) is nonspecific, double vision/ptosis (B) suggests myasthenia gravis, and sensory loss (D) is not typical of ALS.
If the client begins to have a seizure after the EEG, which action should the nurse take first?
- A. Administer oxygen by nasal cannula.
- B. Measure the blood pressure and pulse.
- C. Check the client's pupils.
- D. Place the client in a side-lying position.
Correct Answer: D
Rationale: Placing the client in a side-lying position prevents aspiration and maintains airway patency during a seizure.
The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, 'I don’t know what you mean. What are auras?' Which statement by the nurse would be the best response?
- A. Some people have a warning that the seizure is about to start.'
- B. Auras occur when you are physically and psychologically exhausted.'
- C. You’re concerned that you do not have auras before your seizures?'
- D. Auras usually cause you to be sleepy after you have a seizure.'
Correct Answer: A
Rationale: Auras are sensory warnings preceding a seizure (A), and this response accurately educates the client. Other options misdefine auras (B, D) or fail to address the question (C).
The nurse is caring for a client who has had a stroke. Which nursing intervention is most appropriate to prevent contractures in the affected limbs?
- A. Perform passive range-of-motion exercises daily.
- B. Apply splints to the affected limbs continuously.
- C. Encourage the client to perform active exercises hourly.
- D. Massage the affected limbs every 4 hours.
Correct Answer: A
Rationale: Passive range-of-motion exercises prevent contractures by maintaining joint mobility in clients with stroke-related paralysis.