Chapter 7: Pathophysiology

A 40-year-old female has been diagnosed with hepatocellular carcinoma. When asked what causes this cancer, the physician looks at the history and responds, "I see in your history, you have had: A) Hepatitis B related to IV drug use as a teenager." B) Numerous admissions for COPD exacerbations requiring steroids." C) Three miscarriages with no live births." D) Your uterus and ovaries removed for endometriosis."

A) Hepatitis B related to IV drug use as a teenager."

A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body mass index. Which of the following facts underlies the relationship between obesity and cancer? A) Obesity can cause inflammation and hormonal changes that are associated with cancer. B) Adipose tissue is more susceptible to malignancy than other types of connective tissue. C) Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation. D) Increased numbers of body cells increase the statistical chances of neoplastic cell changes.

A) Obesity can cause inflammation and hormonal changes that are associated with cancer.

A client's oncologist has presented the possibility of implementing biotherapy in the treatment of the client's brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply. A) Stimulating the immune response to tumor cells B) Inhibiting tumor protein synthesis C) Reversing angiogenesis D) Altering the hormonal environment of tumor cells E) Causing breaks in the DNA of tumor cells

A) Stimulating the immune response to tumor cells B) Inhibiting tumor protein synthesis

A male client with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases. His family shares with the nurse that even though he is usually a "big eater," he just isn't interested in food. This has resulted in a loss of muscle mass. Which of the following factors may underlie the client's change in nutritional status? A) The action of cytokines and persistent inflammation B) Loss of appetite due to fatigue and pain C) Changes in peptide hormone levels D) Production of onconeural antigens by cancerous cells

A) The action of cytokines and persistent inflammation

While looking at cancer cells under a microscope, the instructor asks the students to describe the cells. Which of the student answers are accurate? Select all that apply. A) The cells are in different sizes and shapes. B) The nucleoli are larger than normal. C) The cells are contact inhibited. D) The cells do not resemble the tissue of origin. E) The cells are attached to an extracellular matrix.

A) The cells are in different sizes and shapes. B) The nucleoli are larger than normal. D) The cells do not resemble the tissue of origin.

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which of the following characteristics is associated with this client's neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the client's tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.

A) The tumor will grow by expansion and is likely encapsulated.

Which of the following processes characterizes an epigenetic contribution to oncogenesis? A) A DNA repair mechanism is disrupted. B) A tumor suppressor gene is present, but it is not expressed. C) Cells lose their normal contact inhibition. D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

B) A tumor suppressor gene is present, but it is not expressed.

While studying to become chemo-certified, the nurse reviews some basic concepts about cancer cells. When a client asks about why the tumor grows so fast, the nurse will respond based on which of the following physiological principles? Select all that apply. A) Cancer cells have shorter cell cycle times than normal cells. B) Cancer cells do not die when they are programmed to die. C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase. D) Cancer cells will reach a balance between cell birth and cell death rate. E) Cancer cells never reach a flattened growth rate.

B) Cancer cells do not die when they are programmed to die. C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase.

A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The oncologist sits down with the client/family to explain treatment options. The nurse knows that which of the following treatment options will be discussed for her cancers? A) Radiation therapy B) Chemotherapy C) Surgery D) Hormone therapy

B) Chemotherapy

A client with nonspecific signs/symptoms has gone to the primary health care provider. The client's chief complaints revolve around extreme fatigue, unplanned weight loss, and being so weak in the muscles. The diagnostic workup included a carcinoembryonic antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate the physician will order which of the following diagnostic tests related to the elevated CEA? Select all that apply. A) Testicular ultrasound B) Colonoscopy C) Mammogram D) Thyroid scan E) Brain CT

B) Colonoscopy C) Mammogram

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted: A) Procoagulants B) Growth factors C) Attachment factors D) Proteolytic enzymes

B) Growth factors

Although clinical manifestations vary with the type of cancer and organs involved, the oncology nurses have observed that the most frequent side effects clients with cancer experience are: Select all that apply. A) Copious lymph flow B) Sleep disturbances C) Involuntary weight gain D) Visceral organ expansion E) Lack of energy

B) Sleep disturbances E) Lack of energy

Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer? A) "As much as possible, try to eat organic foods." B) "Regular vitamin supplements and a low-carbohydrate diet are beneficial." C) "Try to minimize fat and maximize fiber when you're planning your meals." D) "Eat enough fiber in your diet that you have bowel movement at least once daily."

C) "Try to minimize fat and maximize fiber when you're planning your meals."

A 5-year-old girl's diagnosis of bone cancer required an aggressive treatment regimen. The client immediately receives doxorubicin chemotherapy. The nurse administering this medication should perform a detailed assessment of which body system that has been greatly affected by this drug? A) CNS B) Renal C) Cardiac D) Respiratory

C) Cardiac

A farmer's long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmer's lungs? A) Promotion B) Progression C) Initiation D) Differentiation

C) Initiation

A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by: A) Increasing tissue blood flow B) Providing essential nutrients C) Liberating enzymes and toxins D) Forming fibrous membranes

C) Liberating enzymes and toxins

A client had a positive Pap smear. The surgeon diagnosed "cancer in situ of the cervix." The client asks, "What does this mean?" From the following statements, which is most appropriate in response to this question? The tumor has: A) Been walled off within a strong fibrous capsule B) Developed a distant infiltration C) Not crossed the basement membrane, so it can be surgically removed with little chance of growing back D) Grown undifferentiated cells that no longer look like the tissue from which it arose

C) Not crossed the basement membrane, so it can be surgically removed with little chance of growing back

A 2-year-old child has been diagnosed with neuroblastoma. The tumor is extremely large. Parents ask how this cancer could be so extensive, yet the child has not displayed many symptoms until this past week. Nurses explain that early diagnosis of childhood cancers is often difficult because the signs and symptoms are: A) Already present at birth B) Absent until the late stage C) Similar to those of other childhood diseases D) Seen as developmental delays

C) Similar to those of other childhood diseases

An oncology nurse is caring for a client with newly diagnosed B-cell lymphoma. Extensive blood work has been drawn and sent to the lab. Results reveal an elevated antiapoptotic protein BCL-2 level. The client/family asks, "What does this mean?" The health care provider bases his or her response on the fact that: A) The client's immune system is trying to kill the cancer cell by sending this protein to engulf it. B) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any way. C) This means the cancer cells have found a way to survive and grow even with damaged DNA. D) The client's body is trying to limit the blood supply to the cancer cells by producing high levels of this protein.

C) This means the cancer cells have found a way to survive and grow even with damaged DNA.

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your: A) Tumor is very small and has zero number of mitoses. B) Tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes. C) Tumor is large and at least two lymph nodes are positive for cancer cells. D) Extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.

C) Tumor is large and at least two lymph nodes are positive for cancer cells.

Following routine colonoscopy screening, a client is told that he had several polyps removed. The client began crying stating, "I just can't deal with cancer. I'm too young." The nurse responds: A) "Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help you fight it." B) "Maybe if you're lucky, they have stopped it from metastasizing to your liver." C) "A simple intestinal surgery will cure you." D) "Most colon polyps are not cancerous. The biopsy results will direct your care."

D) "Most colon polyps are not cancerous. The biopsy results will direct your care."

Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms? A) Liver cancer B) Multiple myeloma C) Leukemia D) Breast cancer

D) Breast cancer

Which of the following subjective/objective findings can be considered an adverse effect to the radiation treatment the client is undergoing to "shrink" a tumor prior to surgery? Select all that apply. A) Urine output less than 30 mL/hr (low) B) Increase production of nasal secretions C) Stiff, painful joints in the AM D) Hemoglobin 9.0 g/dL (low)] E) Complains of frequent nausea and vomiting

D) Hemoglobin 9.0 g/dL (low)] E) Complains of frequent nausea and vomiting

Paraneoplastic syndromes are manifestations of cancer that often result from: A) Radiation and chemotherapy B) Compression of area vessels C) Tumor-related tissue necrosis D) Inappropriate hormone release

D) Inappropriate hormone release

A client is scheduled for a bronchoscopy related to a history of "bronchitis" for the last 3 months that has been unresponsive to antibiotics. The nurse shares with the client that a primary purpose for this bronchoscopy is to help diagnose the problem by: A) Visualizing airways looking for adhesions B) Opening airways looking for any aspirated food C) Flushing out the airway to remove debris and sputum D) Taking tissue biopsy and looking for abnormal cells

D) Taking tissue biopsy and looking for abnormal cells