Module 8 Exam

A nurse is discussing benign tumors. Which information should the nurse include?

Benign tumors are usually surrounded by a capsule.

A patient has a decreased platelet count from cancer and the chemotherapy treatment. Which complication is most likely to occur?

Bleeding. Feedback: Bleeding can result from thrombocytopenia, a decrease in platelets.

A patient has mutations in BRCA1 and BRCA2. What type of cancer should the nurse monitor for in this patient?

Breast

The nurse is reviewing the laboratory results of a patient with an elevated BRCA1. What type of cancer does the nurse suspect the patient has?

Breast

A patient is experiencing the wasting syndrome associated with cancer and cancer treatment. What term should the nurse use when documenting this finding?

Cachexia

Which term should the nurse use when describing malignant tumors?

Cancer

In the cancer patient, the expansion/proliferation process is explaining by which statement?

Cancer cells proliferate faster than the normal, nonmutant cells. Feedback: Contact inhibition allows cancer cells to replicate and continue to crowd, eventually piling up on each other. A mutant cell may have a selective advantage over its neighbors; its progeny can accumulate faster than its nonmutant neighbors. This is referred to as clonal proliferation or clonal expansion.

A patient has cancer in the epithelial tissue. Which diagnosis will the nurse observe documented on the chart?

Carcinoma

A nurse is discussing the genes that maintain gene integrity. Which gene is the nurse describing?

Caretaker Feedback: These repair mechanisms are directed by caretaker genes, or genes that are responsible for the maintenance of genomic integrity.

A patient has chronic infection by the human papilloma virus (HPV). Which cancer does the nurse identify as most closely linked to HPV?

Cervical

An oncologist is describing the process of gene silencing. Which process will the oncologist discuss?

DNA methylation Feedback: Cells express different characteristics (for example, a liver cell is different from a brain cell) because a different set of genes is allowed to function in each, and the rest of the genes are silenced because of a process called DNA methylation.

A nurse is describing the process of metastasis. Which is necessary in order for metastasis to occur?

Decreased cell adhesions Feedback: Metastasis requires decreased cell adhesions, increased motility, and the presence of lymphatic or blood vessels.

Which of the following treatments to help cancer-related or chemotherapy-related anemia should the nurse discuss with the patient?

Erythropoietin Feedback: Exogenous erythropoietin can be administered to stimulate bone marrow production of red blood cells.

A cancer patient is experiencing cachexia. Which typical assessment finding will the nurse observe in this patient?

Extreme wasting and emaciation Feedback: Cachexia is the most severe form of malnutrition associated with cancer and results in wasting, emaciation, and decreased quality of life.

Neuromuscular dysfunction and the release of inflammatory mediators such as tumor necrosis factor and interleukin-1 are thought to be responsible for which of the following assessment findings of cancer?

Fatigue Feedback: The hypothesized causes of cancer-related fatigue involve the effects of neuromuscular dysfunction and inflammatory mediators on skeletal muscle function

A patient has a Helicobacter pylori infection. Which type of cancer is most closely associated with this type of infection?

Gastric cancer Feedback: A Helicobacter pylori infection, which also causes peptic ulcer disease, is considered a primary risk factor for gastric cancer.

Which of the following factors predisposes a patient who has chronic inflammation to the development of cancer?

Growth factors are released during the resulting inflammation. Feedback: Inflammatory cells release cytokines and growth and survival factors that stimulate local cell proliferation.

Which symptom will surprise the nurse when assessing a patient with cachexia?

Heart murmur Feedback: The syndrome of cachexia includes a constellation of symptoms, including anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism.

A patient has thrombocytopenia from the cancer and cancer treatments. Which condition should the nurse monitor for in this patient?

Hemorrhage Feedback: Thrombocytopenia is a major cause of hemorrhage in persons with cancer.

Which of the following is correct regarding paraneoplastic syndrome?

Hormones are probably causing the signs and symptoms Feedback: Paraneoplastic syndrome is most commonly caused by biologic substances released from the tumor (e.g., hormones) or by an immune response triggered by the tumor.

The nurse is reviewing a patient s laboratory report. Which finding correlates to the patient s diagnosis of cervical cancer?

Human papilloma virus

Which of the following alterations in metabolism does the nurse expect to find in people with cancer?

Increased basic metabolic rate Feedback: The release of cytokines, such as TNF, IL-1, IL-6, and interferons results in increased protein, carbohydrate, and lipid metabolism.

If a patient experiences cancer-causing mutations to proto-oncogenes, which response will the nurse expect?

Increased cell division

What would the nurse expect to occur when a patient's cancer is caused by mutations of a proto-oncogene?

Increased cell division Feedback: Proto-oncogenes normally promote cellular division, and overstimulation of these genes that cause them to function as oncogenes can lead to increased rates of mitosis.

A cancer patient is experiencing pain. The nurse wants the patient to be independent in managing the pain. Which technique should the nurse implement?

Individual-controlled analgesia

A patient with metastatic cancer is receiving chemotherapy and radiation therapy. What is the priority complication the nurse should assess for in this patient?

Infection Feedback: Infection is the most significant cause of complications and death in persons with malignant disease.

A patient is experiencing leukopenia from cancer and chemotherapy treatment. Which condition should the nurse assess for in this patient?

Infection Feedback: Leukopenia, which is manifested by a decreased white blood cell count, increases an individual's risk for infection and sepsis.

When a patient asks the nurse how radiation therapy provides an effective means for treating some forms of cancer, how should the nurse respond?

Ionizing radiation damages the cancer cell's DNA. Feedback: A focused beam of ionizing radiation can cause enough DNA damage to seriously injure or kill tumor cells.

A patient has a cancer that originated in the blood-forming cells. Which form of cancer does this represent?

Leukemia

Which of the following cancers arise from bone marrow stem cells (blood forming cells) and always originate in the bone marrow?

Leukemia

A patient has chronic active hepatitis B infection. Which type of cancer should the nurse assess for in this patient?

Liver Feedback: Chronic active hepatitis B infection can cause increased cell division and mutagenesis in liver cells.

Which of the following is a characteristic of malignant tumors?

Malignant tumors have a tendency to invade surrounding tissue. Feedback: Malignant tumors often invade health tissues.

When explaining cancer that extends to organs or tissues distant from the site of origin, what term should the nurse use?

Metastasis

An oncologist is using the TNM system to stage a patient's cancer. How does the nurse interpret the M part of the system?

Metastasis. Feedback: One common scheme for standardizing staging is the World Health Organization's TNM system: T indicates tumor spread, N indicates node involvement, and M indicates the presence of distant metastasis.

Which of the following statements indicates that a patient needs more teaching about cancer pain?

Most patients with cancer experience pain early in the disease process. Feedback: Although there are many therapies available for treating cancer pain, many newly diagnosed individuals say that severe and untreatable pain is their biggest fear.

For the function of a tumor suppressor to be lost, which of the following mutational routes is most likely to cause cancer in a patient?

Mutation of both copies of a tumor suppressor gene

A newly diagnosed cancer patient is complaining of pain. Which classification of medication should the nurse ask the primary care provider to prescribe?

Narcotics/opioids Feedback: Many modalities are available to treat pain, ranging from combinations of NSAIDs and narcotics.

For which patient symptoms should a nurse administer odansetron?

Nausea and vomiting Feedback: Aggressive antinausea (antiemetic) therapy, including the centrally acting serotonin 5-hydroxytryptamine (5-HT3) antagonists (such as ondansetron or dolasetron), has allowed better tolerance of highly emetogenic protocols.

The nurse is caring for a cancer patient with moderate pain. Which intervention is most appropriate?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Feedback: Many modalities are available to treat pain, ranging from combinations of NSAIDs and narcotics to palliative surgery and radiation therapy.

The nurse is explaining the function of an oncogene. Which statement should the nurse include?

Oncogenes stimulate cancer cell growth.

During a routine physical examination, the patient reveals a family history of cervical cancer. Which screening test can the nurse suggest for early detection of cervical cancer?

Pap test/smear Feedback: Early detection of cellular atypia in a Pap test alerts healthcare providers to the possibility of cervical carcinoma in situ, which can be effectively treated.

The nurse is describing the cell, "RAS." What type of cell is the nurse discussing?

Proto-oncogene

The nurse is caring for a patient with colorectal cancer who is experiencing rectal bleeding. Which laboratory values should the nurse evaluate?

Red blood cell count and hemoglobin from a complete blood count. Feedback: Chronic bleeding and iron deficiency can accompany colorectal or genitourinary malignancy, making the patient prone to anemia. Anemia can be monitored by the red blood cell count and hemoglobin.

A patient has cancer of the connective tissue. Which diagnosis will the nurse observe documented on the chart?

Sarcoma

A patient has a tumor that has regional lymph node involvement, but has not metastized or spread to distant nodes. Which stage will the nurse observe documented on the chart?

Stage II Feedback: Stage II tumors may have evidence of regional lymph node spread but have not yet spread to distant lymph nodes or other tissues.

A patient has a tumor that has distant lymph node involvement but no evidence of distant metastasis to other tissues. How will this be classified on the chart?

Stage III Feedback: Stage III tumors have evidence of regional lymph node spread but no distant metastasis.

When an oncologist determines the size of the tumor, the degree of node involvement, and the extent of distant metastasis, what is the oncologist doing?

Staging Feedback: Determining the size of the tumor, the degree of node involvement, and the extent of distant metastasis is called tumor staging.

A nurse reviews a cancer report that states the growth is carcinoma in situ (CIS). How will the nurse interpret this finding?

The growth is localized to the epithelium. Feedback: CIS growths are localized to the epithelium but have not penetrated the local basement membrane.

A nurse is describing a process in which a piece of one chromosome is moved to another chromosome. What term should the nurse use to describe this process?

Translocation

A patient with cancer has poor muscle functioning and fatigue. Which cytokines/inflammatory mediators does the nurse suspect is causing these problems?

Tumor necrosis factor and interleukin-1

A nurse is discussing the p53 gene. What type of gene is the nurse describing?

Tumor suppressor

An oncologist is presenting information on the mutation of RAS. What response does the nurse expect to occur?

Unregulated proliferation of cancer cells Feedback: A point mutation in the RAS gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation.

A nurse is discussing autocrine stimulation and cancer. Which information should the nurse include? Autocrine stimulation causes:

a cancer cell to grow. Feedback: Some cancers acquire the ability to secrete their own growth factors (for example, platelet-derived growth fator [PDGF]} to stimulate their own growth, a process known as autocrine stimulation.

The nurse is seeking information about proto-oncogenes. Through a reputable source the nurse learns that a proto-oncogene is:

a normal, nonmutant gene. Feedback: A proto-oncogene normally codes for proteins such as growth factors and growth factor receptors. A normal proto-oncogene does not cause cancer.

Which principle should the nurse use to guide nursing care when administering chemotherapeutic agents? Chemotherapeutic agents primarily target:

all rapidly dividing cells. Feedback: Chemotherapeutic agents target cells at certain stages in the cell cycle and therefore tend to cause injury or death to rapidly dividing cells. Populations affected include cancer cells and any healthy tissue undergoing mitosis, including cells of the bone marrow, hair follicle, and gastrointestinal tract.

A patient has colorectal cancer with chronic bleeding and decreased absorption of iron. Which complication is priority?

anemia Feedback: Mechanisms that cause anemia in persons with cancer include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.

In a cancer patient, blood vessel growth toward the tumor occurs through the release of:

angiogenic factors Feedback: Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to deliver oxygen and nutrients to the growing tumor.

Cancer cells ensure an adequate supply of oxygen and nutrients by releasing:

angiogenic factors. Feedback: Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to deliver oxygen and nutrients to the growing tumor.

A nurse is preparing to teach about gene p53. Which information should the nurse include? Normally, the tumor suppressor gene p53 induces:

apoptosis Feedback: Normally, the p53 gene is a tumor suppressor gene that induces apoptosis of injured or mutated cells. Loss of this gene can contribute to the survival of a cancer cell.

A major characteristic of benign tumors is that they:

are usually encapsulated.

Which of the following statements indicates the patient has a good understanding of metastasis? The most common routes of metastasis are through the lymphatic system and:

blood vessels.

Which of the following is the leading cause of death in developed countries?

cancer

Which statement made by the cancer patient indicates the need for more teaching? A major cause of cancer pain is the result of:

cancer cells residing in lymph nodes. Feedback: Cancer cells in lymph nodes are not associated with pain. Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation all can cause pain.

The nurse is asked about the relationship of genetics to the development of cancer. The best response will include which function of the p53 gene? The p53 gene:

causes apoptosis. Feedback: Apoptosis is the main function of p53.

A patient has a mutation in the APC gene. The nurse knows that this is most closely associated with cancer of the:

colon.

A patient has a sarcoma. The nurse explains that sarcomas are cancers that arise from:

connective tissues Feedback: Cancers arising from mesenchymal tissue (including connective tissue, muscle, and bone) usually have the suffix sarcoma.

The nurse reviewing the patient's chart reads that the patient has "cervical carcinoma in situ." The nurse identifies that the cervical carcinoma:

contains cancer cells that have not invaded the surrounding tissue. Feedback: Carcinoma in situ refers to pre-invasive epithelial cancers that have not penetrated the basement membrane.

The normal function of tumor suppressor genes in an individual without cancer is to:

control production of anti-growth signals. Feedback: Normally, tumor suppressor genes control the production of antigrowth signals, thus preventing tumor growth.

Which of the following statements indicate that the nurse needs more teaching about cancer cells? A typical characteristic of cancer cells is:

decreased responsiveness to growth signals.

The nurse should evaluate the cancer patient with fatigue for which of the following?

depression

A nurse is describing an aggregation of cancer cells that accumulates faster than its non-mutant neighbors. Which term is the nurse discussing? Clonal:

expansion. Feedback: Clonal expansion is the term used to describe the rapid proliferation of a mutated cancer cell and its progeny.

During a health fair, the nurse is asked about cancer symptoms. The best response identifies that the most commonly reported symptom is:

fatigue Feedback: Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation all can cause pain.

Which statement indicates that the nurse needs more instruction regarding anemia and cancer? Anemia in individuals with cancer can be the result of:

fatigue. Feedback: Fatigue is a symptom of anemia, not a cause. Mechanisms that cause anemia in persons with cancer include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.

Oncogenes are:

growth stimulators

Malignant tumors have a tendency to:

invade surrounding tissues. Feedback: Malignant tumors often invade surrounding tissues; they also grow rapidly and have a tendency to metastasize.

A patient is preparing to receive adjuvant therapy for cancer. What should the nurse tell the patient to reinforce teaching? This type of therapy:

is given after cancer surgery. Feedback: Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases

A patient is receiving adjuvant therapy. How should the nurse explain this type of therapy to the patient? This type of therapy:

is given after surgery.

A nurse is discussing cancer and anaplasia with a group of nursing students. When describing anaplasia, the nurse is referring to:

loss of cellular differentiation. Feedback: Cancer cells appear undifferentiated, or anaplastic, when compared with normal, mature cells.

A patient asks what causes fatigue related to cancer and cancer therapy. How should the nurse respond? One possible cause is:

malnutrition.

A patient's ovarian cancer has traveled to the bone. What term should the nurse use to describe this finding?

metastasis Feedback: Metastasis occurs when cancer travels to distant sites.

An oncologist is using the TNM system to stage a cancer tumor. The nurse realizes the N will denote:

nodes

A nurse knows that the most common tumor suppressor gene mutation that causes cancer by resisting apoptosis is in:

p53

Which patient will the nurse monitor most often? The patient with a benign tumor located in the:

skull/cranium. Feedback: It is important to recognize that benign neoplasms also can be life-threatening if they enlarge in critical locations, like the brain/skull/cranium.

An oncologist is discussing the process of metastasis. Which information should the oncologist include? For metastasis to occur, tumor cells must be capable of:

surviving in the bloodstream. Feedback: Cancers often spread first to regional lymph nodes through the lymphatics and then to distant organs through the bloodstream.

Immortality in cancer cells is obtained through the production of:

telomerase Feedback: The telomere in normal cells caps the end of each chromosome and prevents unlimited cell division. Cancer cells, like embryonic cells, produce an enzyme called telomerase that helps maintain the telomere and allows the cell to achieve immortality.

A nurse is teaching the staff about tissue loss in cancer wasting. Which information should the nurse include? A factor that contributes to the tissue loss in cancer wasting is:

the release of cytokines. Feedback: Cytokines, including TNF-α, IL-6, and interferon-δ, appear to cause the metabolic alterations associated with tissue loss in cancer wasting.

The cancer patient asks the nurse to explain the purpose of neoadjuvant therapy. The nurse should explain that:

this will help shrink the tumor before surgery. Feedback: Neoadjuvant therapy can shrink a cancer so that surgery may spare more normal tissue.

The patient with cervical cancer is to undergo brachytherapy. The nurse explains that this therapy is:

when a radiation source will be inserted internally into the cervix.

A patient originally had cancer in the liver and the cancer is now in the lungs. What stage will the nurse observe documented on the chart?

4 or IV Feedback: Cancer that has spread to distant sites, such as a liver cancer spreading to lung or a prostate cancer spreading to bone, is stage 4.

Which of the following patients is at highest risk for cancer?

A 70-year-old who smokes. Feedback: Age and smoking are both risk factors for cancer. This patient has TWO risk factors.

A nurse is explaining variant genes to a group of nursing students. When discussing the retinoblastoma gene, what type of gene is the nurse describing?

A tumor-suppressor gene Feedback: One of the first discovered tumor-suppressor genes, the retinoblastoma (RB) gene, normally strongly inhibits the cell division cycle.

The student nurse has overheard the expression "immortality of cancer cells." When explaining this concept to the student nurse, the nurse should include which statement?

Activation of telomerase allows cancer cells to continue dividing. Feedback: Immortality allows cancer cells to somehow activate telomerase to restore and maintain their telomeres, thereby allowing them to continue dividing.

When assessing the cancer patient s pain, which factors impact the patient's pain that the nurse should consider?

All of the above Feedback: Cultural, psychologic, and physiologic factors all play a role in an individual's response to pain.

A patient loses hair from chemotherapy treatment. What term should the nurse use when documenting this in the patient s chart?

Alopecia Feedback: Alopecia is hair loss from chemotherapy toxicity to the hair follicle.

Which of the following terms should the nurse use to describe a genetic event capable of activating oncogenes?

Amplification Feedback: Since the growth promoting effect of oncogenes must involve overexpression of the gene, amplification is a genetic event that can activate an oncogene.

When a cancer patient has a hemoglobin of 8 mg/dL, what condition will the nurse observe documented on the chart?

Anemia Feedback: Anemia is commonly associated with malignancy, with 20% of persons diagnosed with cancer having hemoglobin concentrations less than 9 g/dL (normal value = 15 g/dL).

A nurse is discussing the process of triggering new blood vessel formation in a tumor. What process is the nurse describing?

Angiogenesis Feedback: Angiogenesis is the formation of new blood vessels. Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to support the growing tumor.