A nurse is caring for a client who is having surgery for the removal of an encapsulated acoustic tumor. Which of the following potential complications should the nurse monitor for postoperatively? (Select all that apply.)

Brain tumor location determines the type of neurological symptoms a client experiences. The frontal lobe is responsible for personality, judgment, voluntary motor control, and memory, so tumors here often cause behavioral changes, weakness, and cognitive deficits. Symptoms such as right-sided weakness indicate involvement of the motor cortex, while personality and memory changes reflect disruption of frontal lobe function. Recognizing these patterns assists in localizing brain tumors and guiding further evaluation.

Rationale for correct answer:

A. Frontal lobe: Controls personality, voluntary motor activity, and higher cognitive functions. Tumors here cause weakness, personality changes, and memory deficits consistent with the client’s presentation.

Rationale for incorrect answers:
B. Parietal lobe: Primarily involved in sensory interpretation and spatial awareness. Tumors here typically cause sensory loss or neglect rather than personality changes.
C. Occipital lobe: Responsible for vision and visual processing. While visual disturbances may occur, isolated occipital tumors would not cause personality changes or hemiparesis.
D. Temporal lobe: Involved in auditory processing and language interpretation. Tumors here are more likely to cause aphasia, auditory hallucinations, or memory issues without hemiparesis.

Take home points

• Frontal lobe tumors often cause personality changes, cognitive deficits, and contralateral weakness.
• Tumor location correlates closely with neurological presentation, guiding diagnostic evaluation.
• Symptom mapping helps clinicians localize and prioritize brain imaging studies.

Increased intracranial pressure (ICP) occurs when the volume of brain tissue, blood, or cerebrospinal fluid rises within the rigid skull. This condition leads to impaired cerebral perfusion, which can quickly progress to brain herniation if unaddressed. Early recognition of signs and symptoms is critical for preventing permanent neurological damage. Common early findings include changes in mental status, behavioral changes, headache, and pupil abnormalities, which reflect pressure on brain tissue and cranial nerves.

Rationale for correct answers:

A. Disoriented to time and place: Confusion and disorientation are early indicators of cerebral hypoperfusion. They reflect rising ICP affecting the cerebral cortex.

B. Restlessness and irritability: These are early behavioral changes caused by decreased cerebral oxygenation and pressure on brain tissue. They often precede more severe neurological deterioration.

C. Unequal pupils: Indicates pressure on cranial nerve III or brain herniation risk. Pupil asymmetry is a critical neurologic warning sign.

E. Headache: A common manifestation of stretching meninges and pressure changes. It often worsens with coughing, straining, or position changes.

Rationale for incorrect answer:
D. ICP 15 mmHg: Normal ICP ranges from 10–15 mmHg, so 15 is at the upper limit but not elevated. Clinically significant ICP is typically >20 mmHg.

Take home points

• Early signs of ICP increase include confusion, restlessness, headache, and pupil changes.
• Unequal pupils are an emergency indicator of possible herniation.
• ICP is considered elevated above 20 mmHg, requiring prompt intervention.