A nurse is providing post-operative care for a patient who has undergone a craniotomy for a brain tumor. Which of the following are essential nursing interventions in the immediate post-operative period? Select all that apply.
Position the patient with the head of the bed elevated to 30−45∘.
Monitor for fluid balance and signs of diabetes insipidus.
Encourage the patient to cough and deep breathe frequently to prevent pneumonia.
Perform frequent neurological checks to detect changes in status.
Administer pain medication only after a physician's approval.
Correct Answer : A,B,D
Post-operative care after a craniotomy requires close monitoring and specific interventions to prevent complications and promote recovery. Proper head elevation helps reduce intracranial pressure, while vigilant fluid balance monitoring is essential for early detection of diabetes insipidus, a common complication. Frequent neurological assessments enable early recognition of changes that may indicate bleeding or swelling. Some interventions, like coughing, must be carefully managed to avoid increasing intracranial pressure.
Rationale for correct answers:
A. Position the patient with the head of the bed elevated to 30−45°: Elevating the head facilitates venous drainage from the brain and reduces ICP.
B. Monitor for fluid balance and signs of diabetes insipidus: Surgery near the pituitary can cause DI, leading to severe fluid imbalances that need early detection and treatment.
D. Perform frequent neurological checks to detect changes in status: Continuous monitoring helps detect deterioration early, guiding timely interventions.
Rationale for incorrect answers:
C. Encourage the patient to cough and deep breathe frequently to prevent pneumonia: While important, coughing can increase ICP and may be contraindicated or done cautiously after brain surgery.
E. Administer pain medication only after a physician's approval: Nurses can usually administer prescribed pain medications per protocol; delaying pain control can increase patient stress and ICP.
Take home points
- Head elevation, fluid monitoring, and neuro checks are critical post-craniotomy.
- Coughing should be carefully timed to avoid spikes in ICP.
- Pain management should be timely to reduce stress and complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D","E"]
Explanation
Treatment of brain tumors is highly individualized and depends on a combination of tumor characteristics and patient factors. Key determinants include the tumor’s growth rate, location, malignancy status, and histologic type. The likelihood of recurrence is also considered because it influences long-term planning and the aggressiveness of therapy. A multidisciplinary approach ensures that treatment is tailored for optimal outcomes.
Rationale for correct answers:
A. Rate of growth of the tumor: Rapidly growing tumors require urgent or aggressive therapy, while slow-growing tumors may allow for conservative management or observation.
B. Whether the tumor is malignant or benign: Malignant tumors typically require multimodal therapy (surgery, radiation, chemotherapy), while benign tumors may be managed with surgery or monitoring.
C. Cell type from which the tumor originates: Histology guides treatment because tumor type determines responsiveness to chemotherapy and radiation.
D. Location within the brain: Tumor site impacts surgical accessibility, neurological risk, and treatment planning.
E. Whether the tumor will reoccur: Anticipated recurrence affects decisions on adjuvant therapy and the intensity of follow-up care.
Rationale for incorrect answer:
F. The client’s age and type of insurance: While these may affect access to care, they are not medical determinants of the treatment plan.
Take home points
- Brain tumor treatment is guided by tumor growth rate, type, location, and recurrence risk.
- Benign tumors can still require treatment if they threaten neurological function.
- Long-term planning considers recurrence risk to reduce complications and improve survival.
Correct Answer is B
Explanation
After brain tumor surgery, certain complications may arise related to brain function or fluid balance. One concerning sign is polyuria with dilute urine, which suggests diabetes insipidus (DI)—a potential complication caused by damage to the hypothalamus or pituitary gland during surgery. Early recognition and treatment of DI are critical to prevent severe dehydration and electrolyte imbalance in pediatric patients.
Rationale for correct answer:
B. Voiding large amounts of dilute urine: This indicates possible diabetes insipidus, a common postoperative complication affecting water regulation. It requires prompt medical intervention to manage fluid and electrolyte balance.
Rationale for incorrect answers:
A. Reports occasional headaches: Some headache is common after brain surgery and does not necessarily indicate a complication.
C. Able to walk with use of crutches: Using crutches postoperatively may reflect temporary weakness or recovery status, not a complication.
D. Ventricular–peritoneal: This option is incomplete but likely refers to a shunt placement, which is a treatment, not a reported symptom or complication.
Take home points
- Diabetes insipidus is a serious complication after brain tumor surgery, especially in children.
- Excessive dilute urine warrants urgent evaluation and treatment.
- Headache and mobility changes are expected postoperative findings but require monitoring.
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