A nurse is caring for a client who has just undergone a craniotomy for a supratentorial tumor. Which of the following postoperative prescriptions should the nurse clarify with the provider?
Dexamethasone (Decadron) 30 mg IV bolus BID
Morphine sulfate 2 mg IV bolus PRN every 2 hr for pain
Ondansetron (Zofran) 4 mg IV bolus PRN every 4 to 6 hr for nausea
Phenytoin (Dilantin) 100 mg IV bolus TID
The Correct Answer is B
After a craniotomy for a supratentorial tumor, careful postoperative management is essential to reduce intracranial pressure (ICP) and prevent neurological complications. Opioid analgesics are used cautiously because they can mask neurological changes and depress respirations, which may worsen ICP.
Rationale for correct answer:
B. Morphine sulfate 2 mg IV PRN: Opioids can cause sedation, respiratory depression, and mask neurological decline after craniotomy. Non-opioid analgesics or carefully titrated alternatives are preferred to allow accurate neuro assessment.
Rationale for incorrect answers:
A. Dexamethasone: This corticosteroid reduces cerebral edema and helps control ICP, making it appropriate post-craniotomy. It is commonly prescribed to prevent or manage swelling.
C. Ondansetron: Controlling nausea and vomiting is essential to prevent spikes in ICP, and ondansetron is a safe antiemetic choice. Its use supports comfort without altering neurological assessments.
D. Phenytoin: Seizure prophylaxis is routine after brain surgery because cerebral irritation may trigger seizures. This medication is appropriate and protective postoperatively.
Take home points
- Opioids are generally avoided after craniotomy because they can mask neurological changes and increase ICP risk.
- Steroids, antiemetics, and anticonvulsants are key medications to reduce edema, prevent vomiting, and lower seizure risk.
- Accurate neurological assessment is the priority in the immediate postoperative period.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Medical management of brain tumors often involves a multimodal approach aimed at reducing tumor size, controlling symptoms, and preventing complications. Surgery is commonly performed for tumor removal or debulking, while radiation therapy targets residual or inoperable tumor tissue. Chemotherapy may be used, although its effectiveness is limited by the blood-brain barrier. Treatments like bone marrow transplant or blood transfusion are not part of routine brain tumor management.
Rationale for correct answers:
A. Chemotherapy: Certain agents can cross the blood-brain barrier to shrink or slow tumor growth. It is typically used for malignant or recurrent tumors in combination with other therapies.
B. Radiation: This therapy targets tumor tissue that cannot be completely removed surgically. It helps prevent regrowth and manage inoperable tumors.
C. Surgery: Surgical removal or debulking is often the first step in management. It reduces mass effect and relieves symptoms of increased intracranial pressure.
Rationale for incorrect answers:
D. Bone marrow transplant: This is used for hematologic cancers like leukemia or lymphoma. It does not treat primary brain tumors.
E. Blood transfusion: Transfusions correct anemia but have no effect on tumor treatment. They are only supportive if the patient is critically anemic or undergoing major surgery.
Take home points
- Surgery, radiation, and chemotherapy are the mainstays of brain tumor management.
- Supportive therapies like transfusions do not treat the tumor itself.
- Multimodal treatment is used to reduce tumor burden, relieve symptoms, and prevent recurrence.
Correct Answer is B
Explanation
Stereotactic radiosurgery (SRS) is a highly precise, noninvasive radiation therapy used to treat brain tumors and vascular malformations. It works by focusing multiple beams of radiation on a single target to destroy abnormal cells without opening the skull. This therapy is particularly useful for small or inoperable tumors, as it minimizes damage to healthy brain tissue. SRS offers shorter recovery times and fewer complications compared to traditional brain surgery.
Rationale for correct answer:
B. Very precisely focused radiation destroys tumor cells: SRS delivers converging radiation beams that effectively target and kill tumor cells. It avoids the need for open craniotomy while preserving surrounding brain tissue.
Rationale for incorrect answers:
A. Radioactive seeds are implanted in the brain: This describes brachytherapy, which involves direct radioactive implantation rather than external focused radiation.
C. Tubes are placed to redirect CSF from one area to another: This is a shunt procedure for hydrocephalus and does not treat brain tumors.
D. The cranium is opened with removal of a bone flap to open the dura: This is a craniotomy, an invasive surgical procedure unlike the noninvasive SRS.
Take home points
- SRS is a noninvasive radiation therapy that destroys tumor cells without open surgery.
- Brachytherapy, shunts, and craniotomy are invasive procedures used for different purposes.
- Precision targeting in SRS reduces damage to healthy brain tissue and shortens recovery.
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