PrepU Cellular Regulation

Which of the following is the most common symptom of bladder cancer?

Painless gross hematuria

A client is being treated for acne vulgaris. What contributes to follicular irritation?

overproduction of sebum

A breast tumor is most likely found in what part of the breast?

the upper outer quadrant

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match to a donor."

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

Bone marrow aspiration

More than 50% of individuals with this disease develop pernicious anemia:

Common variable immunodeficiency (CVID)

The nurse is concerned that a school-aged child has iron-deficiency anemia. What did the nurse assess in this client?

Craving for ice cubes In school-aged children, there is an association between iron-deficiency anemia and pica or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness, thumb-sucking, or inquisitive behavior.

The nurse is working with a 40-year-old pregnant woman about to undergo amniocentesis. The nurse provides appropriate education by stating that amniocentesis is performed for a prenatal diagnosis of which condition?

Cystic fibrosis Amniocentesis is used for prenatal diagnosis of chromosomal and some genetic disorders, such as Down syndrome, cystic fibrosis, and Tay-Sachs disease. Amniocentesis is NOT used to diagnose diabetes, thalassemia, or cleft palate.

A client with chronic renal failure has begun treatment with a colony-stimulating factor. What medication does the nurse anticipate administering to the client that will promote the production of blood cells?

Epoetin alfa (Epogen) Colony-stimulating factors are cytokines that prompt the bone marrow to produce, mature, and promote the functions of blood cells. CSFs enable stem cells in bone marrow to differentiate into specific types of cells such as leukocytes, erythrocytes, and platelets. Pharmacologic preparation of CSFs, such as epoetin alfa (Epogen), is used to promote the natural production of blood cells in people whose own hematopoietic functions have become compromised. The other medications in A, B, and D are tumor necrosis factor inhibitors.

Phagocytic dysfunction is characterized by the following. Choose all that apply.

Increased incidence of bacterial infections Chronic eczematoid dermatitis

Why is a Papanicolaou smear done at the first prenatal visit?

It identifies abnormal cervical cells. A Pap smear is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize?

Lifestyle modifications and techniques for preventing thromboembolism The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.

While assessing a client, the nurse notes that the client has numerous freckles on his skin. The nurse interprets this finding as which of the following?

Phenotype Phenotype refers to the person's entire physical, biochemical, and physiologic makeup as determined by the person's genotype and environmental factors. Thus, the client's freckles are observable characteristics of his genotype, his unique genetic makeup including his genes, and any variations therein. Genome refers to the entire genetic complement of an individual genotype. Variable expression refers to the charateristic indicating the degree of severity of a condition.

The nurse is caring for a 3-year-old child with iron deficiency anemia and providing dietary instructions to the parents. Which of the following should be a priority for the nurse to include in the teaching?

Recommending lean meats From the list, meat is the food source with the highest iron content.

Which statement best describes the function of stem cells in the bone marrow?

They produce all blood cells.

In which client would the nurse suspect cancer?

a 45-year-old with thickening in one breast with nipple irritation and retraction and a pink discharge

An elderly woman is seen in the clinic reporting a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a health care provider in over 10 years. What diagnosis would the nurse expect the primary care provider to make?

vulvar cancer The correct diagnosis for this client would be vulvar cancer due to the placement of the lesion, the itching, and the bleeding. The other cancers would have different symptoms and not apply to this client.

A client recently diagnosed with pancreatic cancer tells the nurse, "I don't see any hope for my future." What would be the most appropriate nursing diagnosis for the nurse to formulate to address this health problem?

Hopelessness related to difficulty coping secondary to pancreatic cancer diagnosis

After assessing a client's family history, the nurse determines the need for a genetic referral based on which of the following?

Several relatives diagnosed with colon cancer A genetic referral would be appropriate when the family history reveals several relatives who have been diagnosed with colon cancer because of the associated possible genetic involvement. A history of two or more unexplained miscarriages as well as consanguinity would be appropriate indications for a genetic referral. If the client has problems with unexplained infertility, then this may be an appropriate reason for a genetic referral. However, a sister's infertility due to the spouse's low sperm count would not be an appropriate indication.

A nurse is conducting a teaching session with a group of adolescent females at a local women's health clinic. When describing appropriate screening guidelines for cervical cancer, at which age would the nurse would instruct the group to have their first Pap smear?

21 Although professional medical organizations disagree as to the recommended frequency of screening for cervical cancer, ACOG (2015) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history) since women younger than age 21 are at very low risk of cancer.

The nurse is caring for clients receiving anticoagulant therapy for embolism prevention. Which factors are a part of the intrinsic pathway for coagulation? Select all that apply.

Antihemophilic factor Christmas factor Hageman factor Effective blood coagulation depends on a complex series of events including a combination of blood and tissue factors released from the plasma (the intrinsic pathway) and from injured tissue (the extrinsic pathway). The plasma-released factors are factors VIII, IX, and XII. Factors released from injured tissues are a tissue factor (an incomplete thromboplastin or factor III), plus factors VII and X.

A client is at risk for breast cancer. Which of the following would reflect the client's genotype for this disorder?

Carrier of BRCA1 mutation Genotype for a disorder refers to the genes that are involved, which in this case would be BRCA1 and BRCA2 mutations. The phenotype reflects the clinical manifestations such as a lump in the breast, a positive breast biopsy, and family history of breast cancer.

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient?

Erythropoietin (Epogen) Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin, as in chronic renal disease. This medication stimulates erythropoiesis.

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom?

Esophageal tumor

When describing meiosis to a group of students, which of the following would be most appropriate to include?

It occurs in the reproductive cells of the body.

A nurse is providing care to a client who has undergone a mastectomy. The nurse provides the woman with information about where to obtain a breast prosthesis. This is an example of which type of community-based nursing intervention?

health system referral The nurse is passing along information about the location of and services offered for the client, an example of a health system referral. Health education programs assist clients in making health-related decisions about self-care and use of resources. Health screening programs focus on detecting unrecognized or preclinical illness among individuals such as mammography. Telephone consultation involves listening and providing support, information or instruction given over the phone, and documenting the interaction.

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:

maintaining a patent airway. Rapid growth of cancer cells in the esophagus may put pressure on the adjacent trachea, jeopardizing the airway. Therefore, maintaining a patent airway is the highest care priority for a client with esophageal cancer. Helping the client cope with body image changes, ensuring adequate nutrition, and preventing injury are appropriate for a client with this disease, but are less crucial than maintaining airway patency.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

megaloblasts. Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells (WBCs). Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

The genetic makeup of a particular cell determines the rate at which that cell can complete which action?

Multiply The genetic makeup of a particular cell determines the rate at which that cell can multiply.

The nurse is assessing a middle-aged client with cancer who has lost 1 lb (0.5 kg) in 4 weeks. The client is taking ondansetron for nausea and now has a temperature of 101° F (38.3° C). The fever is indicative of:

infection. Fever is most commonly related to infection. In a neutropenic client, fever frequently occurs in the absence of the usual clinical signs and symptoms of infection. Inadequate nutrition or antiemetic therapy resistance would not result in fever. Fever is not usually expected with most chemotherapy drugs.

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?

methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder?

painless hematuria The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency.

The nurse is caring for a Native American/First Nations client who has been given a diagnosis of terminal cancer. Which reaction does the nurse anticipate?

stoic listening without display of emotion Native Americans/First Nations tend to control their emotions and expressions of physical discomfort, especially among unfamiliar people. Stoicism should not be interpreted as a lack of feeling or caring. In Western culture, whites and blacks tend to freely express positive and negative feelings. Therefore, the nurse would not expect the Native American/First Nations client to present with overwhelming grief, crying loudly, or requesting family members to be contacted immediately.

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?

"The physician is going to use liquid nitrogen to freeze the area." Cryoablation, or cryosurgery, is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers.

A client with pernicious anemia asks why she must take vitamin B12 injections forever. Which is the nurse's best response?

"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of a factor that allows the vitamin to be absorbed." Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of red blood cells in this condition.

A 25-year-old woman is at the primary care provider for her annual check up. The nurse educated the woman on risks for cervical cancer. Which question would be important to ask as part of a risk screening?

"Were you sexually active at an early age?" Women that have a history of sexual activity within the first year of getting their menstrual cycle are at increased risk for cervical cancer later in life. Infertility, obesity, and high blood pressure put women more at risk for endometrial cancer.

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells?

Chemically

A group of students are reviewing information about CYP metabolic activity levels based on a person's CYP genotype and drug response. The students demonstrate understanding of this information when they identify which of the following as being associated with poor metabolizers?

Greater risk for toxicity Poor metabolizers may have many adverse effects or toxicities from high blood levels of drugs and thus need a lower dose. Ultrarapid metabolizers have inadequate treatment responses because of the lower drug blood levels and may need a higher dose or more frequent dosing. Intermediate metabolizers have some enzyme acitivity leading to differenes in treatment response.

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?

Histamine When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.

The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?

Iron-chelating drugs Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.

A nurse is teaching a community class about how to decrease the risk of cancer. What is the best food for the nurse to recommend?

Oranges A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs, smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. The chemical process used to decaffeinate coffee contributes to cancer.

Which statement best describes the function of fibrinogen?

Plays a key role in forming blood clots Fibrinogen, the largest share of plasma protein, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding. Globulins function primarily as immunologic agents by preventing or modifying some types of infectious diseases. On the other hand, albumin helps maintain the osmotic pressure that retains fluid in the vascular compartment.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred?

The infant's mother probably had diabetes. The nurse should know that the infant's mother more than likely was a diabetic. The large size of the infant born to a diabetic mother is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of diabetic mothers include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who have abused alcohol, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol syndrome or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

What is the most common breast mass in women?

fibroadenoma A fibroadenoma is a benign mass in the breast. It is the most common breast mass among women.

The nursing student asks the instructor why it is more difficult to develop antiviral drugs than anti-infectives. The nursing instructor's best reply would be which?

Viruses are tiny and replicate inside cells. Antiviral medications are limited in their ability to treat viral infections because viruses are tiny and replicate inside cells, changing how cells work, depending on the type of cell invaded. In comparison, a bacterial organism is relatively large and commonly reproduces outside of cells. This makes antiviral drugs more difficult to develop.

After teaching the multiparous mother about hemolytic disease of the newborn and Rh sensitization, the nurse determines that the client understands why she was not sensitized during her other pregnancy when she makes which statement?

"Antibodies are not usually formed until after exposure to an antigen." The problem of Rh sensitivity arises when the mother's blood develops antibodies after fetal red blood cells enter the maternal circulation. In cases of Rh sensitivity, this usually does not occur until after the first pregnancy. Hence, hemolytic disease of the newborn is rare in a primiparous client. A mismatched blood transfusion in the past or an unrecognized spontaneous abortion could also result in hemolytic disease because the transfusion or abortion would have the same effects on the client. The statement about the other baby having a different father may be true. However, if both fathers were Rh-positive, then sensitization could occur. Most women do not have immunity against the antibodies formed when Rh-positive cells enter the mother's bloodstream. Antibodies are not neutralized by the mother's system.

A client with diabetes whose husband recently died reports elevated blood glucose levels. She admits she is barely eating anything; she does not feel hungry. How will the nurse best respond to this client?

"Often with stress, glucose level increases because the body needs more energy." During stress, the sympathetic nervous system is stimulated to release hormones that produce metabolic effects, including an increased blood glucose level. The rise in glucose is caused by increased liver and mucle glycogen breakdown. This mechanism allows more energy to be available for the body to handle the stressor.

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

"The child must inherit two defective genes, one from each parent."

A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?

All options are correct. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise.

Which of the following is a term used to describe the process by which a new blood supply is formed?

Angiogenesis Angiogenesis is the process by which a new blood supply is formed. Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises.

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?

Biopsy of the axillary lymph nodes The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis.

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following?

Bleeding Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. What vital sign values most support the nurse's analysis?

Blood pressure of 80/40 mm Hg and pulse of 130 beats per minute. Orthostatic changes develop from hypovolemia and cause a drop in blood pressure (evidenced by a blood pressure of 80/40 mm Hg) and a compensatory rise in the heart rate (evidenced by a pulse of 130 beats per minute) when the client rises from a lying position.

A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nurse most likely identify as increasing synaptic transmission?

Neurotransmitter As the electrical action potential reaches the ends of the axons, called terminals, calcium ion channels are opened, allowing an influx of Ca++ ions into the neuron. This increase in calcium stimulates the release of neurotransmitters into the synapse. Rapid signaling among neurons requires a ready supply of neurotransmitter. These neurotransmitters are stored in small vesicles grouped near the cell membrane at the end of the axon. When stimulated, the vesicles containing the neurotransmitter fuse with the cell membrane, and the neurotransmitter is released into the synapse. The neurotransmitter then crosses the synaptic cleft to a receptor site on the postsynaptic neuron and stimulates adjacent neurons.

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the

malignancy is causing the electrolyte imbalance. The client's laboratory findings indicate hypercalcemia. Hypercalcemia is defined as a calcium concentration >10.2 mg/dL (>2.6 mmol/L).The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Malignant tumors can produce hypercalcemia through a variety of mechanisms. The client's calcium level is elevated; there is no indication that the client's diet is lacking in calcium-rich food products. Hyperaldosteronism is not associated with a calcium imbalance. Alcohol abuse is associated with hypocalcemia.

A client with cirrhosis should be encouraged to follow which diet?

well-balanced normal nutrients, low-sodium diet Cirrhosis is a slowly progressive disease. Inadequate nutrition is the primary ongoing problem. Clients are encouraged to eat normal, well-balanced diets and to restrict sodium to prevent fluid retention. There is no need to increase calories or potassium or to adopt a bland diet. Protein is not restricted until the liver actually fails, which is usually late in the disease.

During a routine checkup, a client refers to a recent change in the color of the skin. Which of the following should the nurse suggest to the client?

Make an appointment for a medical examination as soon as possible.

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?

Orange juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition?

Kaposi sarcoma Kaposi sarcoma is a frequent comorbidity in clients with AIDS. With platelet disorders, the nurse observes ecchymoses (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in the client with syphilis.