Cellular Regulation

The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow

ANS: A Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow.

A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best? a. "Maybe; preservatives, dyes, and preparation methods may be risk factors." b. "No; research studies have never shown those things to cause cancer." c. "There are other things you can do that will more effectively lower your risk." d. "Yes; preservatives and dyes are well known to be carcinogens."

ANS: A Dietary factors related to cancer development are poorly understood, although dietary practices are suspected to alter cancer risk. Suspected dietary risk factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer-promoting effects. It is correct to say that other things can lower risk more effectively, but this does not give the client concrete information about how to do so, and also does not answer the client's question.

A female patient complains of a "scab that just won't heal" under her left breast. During your conversation, she also mentions chronic fatigue, loss of appetite, and slight cough, attributed to allergies. What are the nurse's next steps? a. Continue to conduct a symptom analysis to better understand the patient's symptoms and concerns. b. End the appointment and tell the patient to use skin protection during sun exposure. c. Suggest further testing with a cancer specialist and provide the appropriate literature. d. Tell her to put a bandage on the scab and set a follow-up appointment in one week.

ANS: A A comprehensive health history is vital to treating and caring for the patient. Often times, symptoms are vague. The nurse should conduct a symptom analysis to gather as much information as possible. Questions should address the duration of the symptoms and include the location, characteristics, aggravating and relief factors, and any treatments taken thus far.

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? a. "My mother and grandmother had breast cancer, so I am at risk." b. "I get a mammogram every 2 years since I turned 30." c. "A clinical breast examination is performed every month since I turned 40." d. "A computed tomography (CT) scan will be done every year after I turn 50."

ANS: A A strong family history of breast cancer indicates a risk for breast cancer. Annual rather than biannual screening may be indicated for a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. An annual mammogram is performed after age 40 or in younger clients with a strong family history.

The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? a. "My mother and grandmother had breast cancer, so I am at risk." b. "I get a mammography every 2 years since I turned 30." c. "A clinical breast examination is performed every month since I turned 40." d. "A CT scan will be done every year after I turn 50."

ANS: A A strong family history of breast cancer indicates a risk for breast cancer. Annual screening may be indicated for a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. An annual mammography is performed after age 40 or in younger clients with a strong family history.

When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? a. Tobacco use b. Ethnicity c. Gender d. Increased age

ANS: A Although all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change. Ethnicity, gender, and increasing age are associated with lung cancer, but they are not modifiable risks.

Which description about genetic screening is correct? a. It identifies genetic risk for specific cancers. b. The tests are performed on cerebrospinal fluid samples. c. A positive test diagnoses cancer in the client. d. The test results are shared with the client's family.

ANS: A Genetic screening helps to identify if a client has a genetic risk for specific cancers. The tests are performed only on blood samples. A positive test indicates the presence of a mutated gene that may cause cancer; however, the cancer may never develop. The test result is not shared with the client's family; it is the client's privilege to maintain secrecy or disclose the contents of the test to the family.

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? a. Infection with hepatitis B virus b. Consuming a diet high in animal fat c. Exposure to radon d. Familial polyposis

ANS: A Hepatitis B and C are risk factors for primary liver cancer. Alcohol abuse is also a risk factor for the development of liver cancer. Consuming a diet high in animal fat may predispose a person to colon or breast cancer. Exposure to radon is a risk factor for lung cancer. Familial polyposis is a risk factor for colorectal cancer.

While planning care for a patient experiencing fatigue due to chemotherapy, which of the following is the most appropriate nursing intervention? a. Prioritization and administration of nursing care throughout the day b. Completing all nursing care in the morning so the patient can rest the remainder of the day c. Completing all nursing care in the evening when the patient is more rested d. Limiting visitors, thus promoting the maximal amount of hours for sleep

ANS: A Pacing activities throughout the day conserves energy, and nursing care should be paced as well. Fatigue is a common side effect of cancer and treatment; and while adequate sleep is important, an increase in the number of hours slept will not resolve the fatigue. Restriction of visitors does not promote healthy coping and can result in feelings of isolation.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? a. Testing of stool specimens for occult blood b. Teaching about the importance of dietary fiber c. Referring clients for colonoscopy procedures d. Giving vitamin and mineral supplements

ANS: A Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants. Client education is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care is best performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing personnel.

A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, "I just don't know how this could have happened to me." Which of these responses by the nurse will be most appropriate? a. "Tell me what you mean when you say you don't know how this could have happened to you." b. "Do you have a family history that might make you more likely to develop breast cancer?" c. "Would you like me to help you find more information about how breast cancer develops?" d. "Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it."

ANS: A The client's statement may indicate shock and denial or a request for more information. To provide appropriate care, further assessment is needed about the client's psychosocial status. The first action by the nurse in this situation is to obtain more data by asking open-ended questions.

Which of the following statements is essential when teaching a patient who has received an injection of iodine-131? a. "Do not share a toilet with anyone else for 3 days." b. "You need to save all your urine for the next 7 days." c. "No special precautions are needed, because this is a weak type of radiation." d. "You need to avoid contact with everyone except family members until the radiation device is removed."

ANS: A The radiation source is an unsealed isotope that is eliminated from the body mainly through urine and feces. This material is radioactive for about 48 hours after instillation. The patient should not share a toilet with others for 3 days to ensure the isotope has been completely eliminated and is no longer radioactive. Saving the urine is not necessary. Contact should be avoided with anyone who may be ill or immunocompromised. Patients are instructed to avoid crowded areas but isolation is not necessary.

What priority intervention will the nurse employ to prevent injury to the patient with bone cancer? a. Using a lift sheet when repositioning the patient b. Positioning the patient so the heels do not touch the mattress c. Providing small, frequent meals rich in calcium and phosphorus d. Applying pressure for a full 5 minutes after intramuscular injections

ANS: A The resultant bone destruction from bone cancer can cause pathological fractures by grasping or pulling on a patient by the extremities or trunk of the body during re-positioning. Use of a lift sheet evenly distributes the patient's weight, lessening the chance of fractures occurring. While safety risks exist, the priority for bone cancer is reducing risk of fractures.

Which information must the organ transplant nurse emphasize before a client is discharged? a. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." b. "You are at increased risk for cancer when you reach 60 years of age." c. "Immunosuppressant medications will decrease your risk for developing cancers." d. "After 6 months, you may stop immunosuppressant medications, and your risk for cancer will be the same as that of the general population."

ANS: A Use of immunosuppressant medications to prevent organ rejection increases the risk for cancer. Advanced age is a risk factor for all people, not just for organ transplant recipients. Immunosuppressant medications must be taken for the life of the organ; the risk for developing cancer remains.

While collecting a health history on a patient admitted for colon cancer, which of the following questions would be a priority to ask this patient? a. "Have you noticed any blood in your stool?" b. "Have you been experiencing nausea?" c. "Do you have back pain?" d. "Have you noticed any swelling in your abdomen?"

ANS: A Early colon cancer is often asymptomatic, with occult or frank blood in the stool being an assessment finding in a patient diagnosed with colon cancer. If pain is present, it is usually lower abdominal cramping. Constipation and diarrhea are more frequent findings than nausea or ascites.

The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.) a. Exposure to carcinogens b. Genetic predisposition c. Immune function d. Normal doubling time e. State of euploidy

ANS: A, B, C The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function.

A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. a. Brain b. Bone c. Lymph node d. Kidney e. Liver

ANS: A, B, C, E Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Kidneys are not a typical site of lung cancer metastasis.

A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing d. Near-daily abdominal pain e. Obvious change in a mole

ANS: A, B, C, E The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign.

The nurse includes which factors in teaching regarding the typical warning signs of cancer? Select all that apply. a. Persistent constipation b. Scab present for 6 months c. Curdlike vaginal discharge d. Axillary swelling e. Headache

ANS: A, B, D Change in bowel habits, a sore throat that does not heal, and a lump or thickening in the breast or elsewhere are all potential warning signs of cancer. Curdlike vaginal discharge represents a yeast infection. Headache is not a warning sign, but may be present with multiple problems.

A client wishes to undergo genetic testing to determine cancer predisposition. What preliminary information does the nurse provide to this client about genetic testing? Select all that apply. a. Genetic testing is expensive. b. The test is performed on saliva. c. The test is performed on blood. d. It is helpful in diagnosing cancer. e. Insurance usually covers the cost.

ANS: A, C Genetic testing is an expensive procedure that uses the client's blood to rule out a person's genetic risk for a few specific cancers. Genetic testing is helpful only in detecting the risk for cancer, not for diagnosing the presence of cancer. Insurance companies generally do not cover the cost of genetic testing.

What are the features of a normal cell? Select all that apply. a. Low mitotic index b. Anaplastic c. Tight adherence d. Euploidy e. Migratory

ANS: A, C, D At any given time, there are few actively dividing cells. Normal cells have a low mitotic index. Normal cells with the exception of red blood cells produce proteins that protrude from the membranes, allowing the cells to bind tightly together. This results in normal cells being nonmigratory and prevents cells wandering from one tissue to the next. Normal chromosomes or euploidy is a characteristic feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for human beings. Malignant cells or cancer cells are anaplastic; they lose the specific appearance of their parent cells. As a cancer cell becomes more malignant, it becomes smaller and rounded. They have large nuclear-to-cytoplasmic ratio. Normal cells have specific morphological features with small nuclear-to-cytoplasmic ratio. Cancer cells migrate because they have many enzymes on their cell surfaces and do not bind tightly to each other.

The nurse is planning care for a patient with hypercalcemia secondary to bone metastasis. Which of the following interventions will be included in the plan of care? (Select all that apply.) a. Increasing oral fluids b. Placement of an oral airway at the bedside c. Monitoring for Chvostek's sign d. Implementing seizure precautions e. Hyperactive reflex assessment f. Observation for muscle weakness

ANS: A, D Serious complications of hypercalcemia include severe muscle weakness, dehydration, loss of deep tendon reflexes, paralytic ileus, and electrocardiographic changes. Early manifestations of hypercalcemia include fatigue, loss of appetite, nausea, vomiting, constipation, and polyuria (increased urine output).

The nursing student learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.) a. Differentiated function b. Large nucleus-to-cytoplasm ratio c. Loose adherence d. Nonmigratory e. Specific morphology

ANS: A, D, E Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and well-regulated growth.

A client is at risk for developing colon cancer. What are the various preventive interventions that the nurse may plan to implement? Select all that apply. a. Suggest taking aspirin. b. Administer the vaccine Gardasil. c. Encourage a diet rich in fiber and fat. d. Suggest limiting the number of sexual partners. e. Refer for a polypectomy if the client has associated polyps.

ANS: A, E Clients who are at risk for developing colon cancer may begin taking aspirin, and removing at-risk tissues like associated polyps, if present, to reduce their risk. Gardasil is a vaccine effective against cervical cancer. The client should be encouraged to have a diet rich in fiber and low in fat. Limiting sexual partners is a practice helpful in preventing cervical cancer.

A client asks if there are any drugs which help to prevent the development of cancer. How does the nurse respond? Select all that apply. a. Aspirin (acetylsalicylic acid) reduces the risk of colon cancer. b. Lycopene reduces the risk of prostate cancer. c. Tamoxifen (Nalvodex) reduces the risk of breast cancer. d. There are no drugs which prevent the development of cancer. e. Anticancer drugs can be used as preventive therapy.

ANS: A,B,C The drug therapies that have proven preventive roles for various cancers are aspirin for colon cancer, lycopene for prostate cancer, and tamoxifen for breast cancer. The client should not be encouraged to use anti-cancer drugs because they are associated with a higher risk for developing serious toxic effects. At the same time, they increase the risk of developing other cancers.

Which dietary modifications can the nurse recommend to a client for preventing cancer development? Select all that apply. a. Increasing broccoli intake b. Increasing red meat consumption c. Consuming more dietary bran d. Eating more sausage and bacon e. Restricting alcohol consumption to less than 2 drinks per day

ANS: A,C,E The dietary modifications that can help in reducing cancer development include eating broccoli, cauliflower, sprouts, cabbage, and dietary bran. Restricting alcohol consumption to less than 2 drinks per day also reduces the risk of developing cancer. Consuming animal fats like red meat, sausage, and bacon increase the risk for developing cancer, so their consumption should be restricted.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? a. Easy bruising b. Dyspnea c. Night sweats d. Chest wound

ANS: B Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia. Easy bruising is a nonspecific finding. Night sweats is a symptom of the lymphomas. A chest wound is not specific to lung cancer.

The nurse providing care for a patient with suspected cancer recalls that the only diagnostic procedure that is definitive for a diagnosis of cancer is: a. MRI b. Biopsy c. CT scan d. Tumor marker

ANS: B Only a biopsy is a definitive means of diagnosing cancer, because it actually identifies the pathological cells. Many tests, such as MRI, CT scan, and tumor markers, are indicative of cancer, but they do not confirm the presence of cancer cells as examination of a specimen obtained by biopsy does.

Which activity performed by the community health nurse best reflects primary prevention of cancer? a. Assisting women to obtain free mammograms b. Teaching a class on cancer prevention c. Encouraging long-term smokers to get a chest x-ray d. Encouraging sexually active women to get annual Papanicolaou (Pap) smears

ANS: B Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. Mammography is part of a secondary level of prevention, defined as screening for early detection. Chest x-ray is a method of detecting a cancer that is present—secondary prevention and early detection. A Pap smear is a means of detecting cervical cancer early—secondary prevention.

The nurse would incorporate which of the following into the plan of care as a primary prevention strategy for reduction of the risk for cancer? a. Yearly mammography for women aged 40 years and older b. Using skin protection during sun exposure while at the beach c. Colonoscopy at age 50 and every 10 years as follow-up d. Yearly prostate specific antigen (PSA) and digital rectal exam for men aged 50 and over

ANS: B Primary prevention of cancer involves avoidance to known causes of cancer, such as sun exposure. Secondary screening involves physical and diagnostic examination.

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? a. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." b. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." c. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." d. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

ANS: B T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.

Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? a. Cure of the cancer b. Relief of symptoms or improved quality of life c. Allowing other therapies to be more effective d. Prolonging the client's survival time

ANS: B The focus of palliative surgery is to improve quality of life during the survival time.

The nurse is assessing a client for bladder cancer. About which sign or symptom does the nurse ask the client? a. Unexplained fevers b. Presence of blood in the urine c. History of urinary tract infections d. Change in the size of urine stream

ANS: B The nurse asks the client about presence of blood in the urine which is often found in clients with bladder cancer. Unexplained fevers may be assessed in the client with leukemia. During an assessment for prostate cancer, the nurse would ask the client about a history of urinary tract infections and a change in the size of urine stream because enlargement of the prostate affects the urinary bladder, thereby affecting the size of the urine stream. The client experiences urine retention and has repeated urinary tract infections.

When teaching women about the risk of breast cancer, which risk factor does the nurse know is the most common for the development of the disease? a. Having an aunt with breast cancer b. Being an older adult c. Being a Euro-American d. Consuming a low-fat diet

ANS: B There is no single-known cause for breast cancer. Being an older woman or man is the primary risk factor, although some people are at higher risk than others. Having a first-degree relative (mother, sister, or daughter) with breast cancer can increase the risk; an aunt is not considered a first-degree relative. Although Euro-American women older than 40 years are at a more increased risk than other racial/ethnic groups, the greater risk is being an older adult. Consuming a high-fat diet is considered a risk factor.

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? a. Vomiting b. Back pain c. Frequent urination d. Cyanosis of the toes

ANS: B Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control. Although frequent urination may be a sign of bladder cancer, incontinence is more indicative of spinal metastasis. Cyanosis of the toes indicates decreased tissue perfusion, often related to atherosclerotic disease.

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? (Select all that apply.) a. Limit sodium intake. b. Avoid beef and processed meats. c. Increase consumption of whole grains. d. Eat "colorful fruits and vegetables," including greens. e. Avoid gas-producing vegetables such as cabbage.

ANS: B, C, D Consuming bran and whole grains and avoiding red meat and processed foods such as lunchmeats can reduce cancer risk. Consuming foods high in vitamin A, including apricots, carrots, and leafy green and yellow vegetables, can also reduce cancer risk. Reducing sodium is helpful in the treatment of hypertension and heart and kidney failure; no evidence suggests that lowering of sodium intake decreases the incidence of cancer. Eating cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage may actually reduce cancer risk.

A client has a very high risk for developing breast cancer. What preventive measures may the nurse recommend? Select all that apply. a. Encourage a diet rich in fiber and fat. b. Discuss the need for a mastectomy. c. Suggest the long-term use of vitamin D. d. Explain the need for long-term use of tamoxifen. e. Recommend limiting the number of sexual partners.

ANS: B, C, D Preventive measures for clients who are at high risk for developing breast cancer include the removal of the breast (mastectomy), and long-term intake of vitamin D and tamoxifen. The client should be encouraged to consume a diet rich in fiber and low in fat. Limiting the number of sexual partners is helpful in preventing cervical cancer, not breast cancer.

A patient diagnosed with benign lipoma is concerned about the tumor spreading to other parts of the body. Which facts should the nurse include when teaching the patient about benign tumors? a. Benign tumors are poorly differentiated. b. Benign tumors have high recurrence rate. c. Benign tumors are not capable of metastasis. d. Benign tumors have moderate vascularity.

ANS: C Benign tumors are not metastatic and not capable of spreading from one organ to another. Benign tumors are normally differentiated, have low vascularity, and their recurrence is rare.

A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) a. Demonstrating breast self-examination methods to women b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers d. Screening teenage girls for cervical cancer e. Teaching teens the dangers of tanning booths

ANS: B, C, E Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods.

What are the common cancers related to tobacco use? Select all that apply. a. Cardiac cancer b. Lung cancer c. Cancer of the tongue d. Skin cancer e. Cancer of the larynx

ANS: B, C, E Organs exposed to the carcinogens in tobacco are the most likely to develop cancer. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other UV exposure such as that found with tanning beds.

A client who is hospitalized has been diagnosed with Epstein-Barr viral infection. What are future malignancies that the client is at risk for developing? Select all that apply. a. Cervical cancer b. B-cell lymphoma c. Burkitt's lymphoma d. Primary liver cancer e. Nasopharyngeal carcinoma

ANS: B, C, E The Epstein-Barr virus predisposes the client to developing B-cell lymphoma, Burkitt's lymphoma, and nasopharyngeal carcinoma. Human papilloma viral infection is a risk factor for cervical cancer. Hepatitis B and C infections are risk factors for primary liver cancer.

The nurse is instructing a client on how to perform breast self-examination (BSE). Which techniques will the nurse include in teaching the client about BSE? Select all that apply. a. Instruct the client to keep her arm by her side while performing the examination. b. Ensure that the setting in which BSE is demonstrated is private and comfortable. c. Ask the client to remove her shirt. The bra may be left in place. d. Ask the client to demonstrate her own method of BSE. e. Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts.

ANS: B, D The setting should be private and comfortable to promote an environment conducive to learning and to prevent potential client embarrassment. Before teaching breast palpation, ask the client to demonstrate her own method, so that the nurse can assess the client's understanding of BSE. For better visualization, the arm should be placed over the head.The client should undress from the waist up. The finger pads, which are more sensitive than the fingertips, are used when palpating the breasts.

The TNM classification report of a client with lung cancer is TisN0Mx. How is this classification interpreted? Select all that apply. a. No metastasis. b. Carcinoma in situ. c. No evidence of the primary tumor. d. Involvement of regional lymph nodes. e. Presence of metastasis cannot be assessed.

ANS: B, E Staging determines the exact location of the cancer and its degree of metastasis at diagnosis. The acronym TNM refers to "Tumor, Nodes, Metastasis." Per the TNM classification, Tis stands for carcinoma in situ. Mx means that the presence of distant metastasis cannot be assessed. The absence of regional lymph node metastasis is indicated by N0.

The nurse is teaching a client about cancer warning signs. Which signs/symptoms does the nurse include? Select all that apply. a. A sore that heals quickly b. Unusual bleeding and discharge c. Change in bowel or bladder habits d. Nagging cough or a hoarse voice e. Long-lasting warts without any observable change

ANS: B,C,E Unusual bleeding and discharge can be a warning sign for the onset of cancer. A change in bowel or bladder habits may be indicative of a malignancy in the intestine and urinary bladder, respectively. Nagging cough or hoarseness can indicate a malignancy of the respiratory airways. A sore that heals quickly indicates an effective wound-healing mechanism, while a non-healing sore can be a cancer warning sign. Long-lasting moles or warts with observable changes may be a warning sign for cancer.

Which of the following findings during a female breast examination should the nurse report as suspicious for breast cancer? a. Multiple nodules of round, lumpy, tender tissue in both breasts b. A single soft, mobile, lobular nodule that is nontender c. A poorly defined, firm lump that is nontender and nonmovable d. A single soft lump that is well-defined and tender

ANS: C A poorly defined, firm lump that is nontender, nonmovable, and fixed to the skin is characteristic of breast cancer. All other choices are usually associated with benign processes. All patients should have a diagnosis of cancer based upon physical assessment and tissue pathology.

nurse is learning about the different types of cancers. Which cancer has the highest incidence among men? a. Lung cancer b. Colon cancer c. Prostate cancer d. Thyroid cancer

ANS: C Among all the cancers in men, prostate cancer has the highest incidence (29%). Lung cancer has the highest death rate among men (29%). The incidence of colon cancer in males is 9%. Thyroid cancer is more common in women than men.

A patient with breast cancer asks the nurse why 6 weeks of daily radiation treatments is necessary. What is the nurse's best response? a. "Your cancer is widespread and requires more than the usual amount of radiation treatment." b. "The cost of larger doses of radiation for a shorter period of time is justified by the results." c. "Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time." d. "It is less likely your hair will fall out or you will become anemic if radiation is given in smaller doses over a longer period of time."

ANS: C Because of the varying responses of all the cancer cells within a given tumor, smaller doses of radiation given on a daily basis for a set period of time provides multiple opportunities for the destruction of cancer cells while minimizing damage to normal tissues.

The nursing instructor explains the difference between normal cells and benign tumor cells. What information does the instructor provide about these cells? a. Benign tumors grow through invasion of other tissue. b. Benign tumors have lost their cellular regulation from contact inhibition. c. Growing in the wrong place or time is typical of benign tumors. d. The loss of characteristics of the parent cells is called anaplasia.

ANS: C Benign tumors are basically normal cells growing in the wrong place or at the wrong time. Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells.

How is the migratory feature of cancer cells explained? a. They have a large nuclear-to-cytoplasmic ratio. b. They lose their specific functions. c. They do not make fibronectin. d. They have a short generation time.

ANS: C Fibronectin is a protein that protrudes from the membrane of normal cells, allowing them to bind tightly together. Cancer cells do not make fibronectin; hence they adhere loosely to each other and break off from the main tumor. These cells easily slip through the walls of the blood vessels and migrate to other body sites. Cancer cells have a large nuclear-to-cytoplasmic ratio; they lose their specific functions and have a short generation time. But it is the absence of fibronectin that makes these cells migratory.

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer? a. Osteogenic sarcoma b. Rhabdomyosarcoma c. Neuroblastoma d. Non-Hodgkin lymphoma

ANS: C Neuroblastoma is found exclusively in infants and children. In most cases of neuroblastoma, a primary abdominal mass and protuberant, firm abdomen are present. Osteogenic sarcoma is a bone tumor. Bone tumors typically affect older children. Rhabdomyosarcoma is a malignancy of muscle, or striated tissue. It occurs most often in the periorbital area, in the head and neck in younger children, or in the trunk and extremities in older children. Non-Hodgkin lymphoma is a neoplasm of lymphoid cells. Painless, enlarged lymph nodes are found in the cervical or axillary region. Abdominal signs and symptoms do not include a mass.

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is most important to communicate to the health care provider? a. "I am allergic to iodine." b. "My urinary stream is very weak." c. "My legs are numb and weak." d. "I am incontinent when I cough."

ANS: C Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur. Prostate cancer may frequently metastasize to the bone, specifically the spine. Allergy to iodine should be reported when contrast media will be used, but dye is not used in radiation therapy. A weak urinary stream and incontinence are common clinical manifestations of prostate cancer. Incontinence associated with coughing is typical of stress incontinence and is not a complication of cancer.

A client who has just had a mastectomy is crying. When the nurse asks about her crying, the client responds, "I know I shouldn't cry because this surgery may well save my life." What is the nurse's best response? a. "It is all right to cry. Mourning this loss will help make you stronger." b. "I know this is hard, but your chances of survival are better now." c. "I can arrange for someone who had a mastectomy to come visit if you like." d. "How have you coped with difficult situations in the past?"

ANS: C Often, cancer surgery involves the loss of a body part or a decrease in function. Mourning or grieving for a body image alteration is a healthy part of adapting or adjusting to a new image. Visiting with someone who has experienced the same situation as the client is very helpful in showing the client that many aspects of life can be the same afterward. If the opportunity to arrange this type of visit is available, this would be the nurse's best response. The other options do not provide any assistance to the client in coping with her new body image and grieving for her loss.

A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? a. "Don't worry, most lumps are discovered by women during breast self-examination." b. "Does anyone in your family have breast cancer?" c. "Finding a cancer in the early stages increases the chance for cure." d. "Have you noticed a lump or thickening in your breast?"

ANS: C Providing truthful information addresses the client's concerns. Mammography can detect lumps smaller than those discovered by palpation. Asking about family history or symptoms is not therapeutic because it does not address the client's fear of cancer.

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer a. Is in situ. b. Has metastasized. c. Has spread locally. d. Has spread extensively.

ANS: C Stage II cancer is associated with local spread. Stage 0 denotes cancer in situ; stage III denotes extensive regional spread, and stage V denotes metastasis.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy? a. Brush the teeth briskly to remove bacteria. b. Use a mouthwash that contains alcohol. c. Inspect the child's mouth daily for ulcers. d. Perform oral hygiene twice a day.

ANS: C The child's mouth is inspected regularly for ulcers. At the first sign of ulceration, an antifungal drug is initiated. The teeth should be brushed with a soft-bristled toothbrush. Excessive force with brushing should be avoided because delicate tissue could be broken, causing infection or bleeding. Mouthwashes containing alcohol may be drying to oral mucosa, thus breaking down the protective barrier of the skin. Oral hygiene should be performed four times a day.

A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? a. "Foods high in vitamin A and vitamin C are important." b. "I'll have to cut down on the amount of bacon I eat." c. "I'm so glad I don't have to give up my juicy steaks." d. "Vegetables, fruit, and high-fiber grains are important."

ANS: C To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct.

Which pathologic description of a client's tumor does the nurse interpret as being the "most malignant" or "high grade" cancer? a. poorly differentiated; mitotic index = 20%, euploid b. Moderately differentiated; mitotic index = 50%, euploid c. Undifferentiated; mitotic index = 50%, aneuploid d. Highly differentiated; mitotic index = 10%, aneuploid

ANS: C Tumors that closely resemble normal cells are "less malignant," and those that have few normal cell features are "more malignant." Thus, those that are euploid are less malignant and those that are aneuploid, with abnormal numbers or structures of chromosomes, are more malignant. Less malignant cells are highly differentiated, and more malignant cells are poorly or undifferentiated. Cells that divide faster (have a higher mitotic index) are more malignant.

What is a known cause of skin cancer? a. Intake of nitrites b. Cigarette smoke c. Tanning beds d. Low-fiber diet

ANS: C Ultraviolet radiation from tanning beds, cosmic radiation, germicidal lights, excessive exposure to the sun, and injuries from burns are known to cause skin cancer. Radiation mutates the genes and can cause cancer among non-dividing cells as well. Intake of nitrites from processed foods such as lunch meats, sausages and bacon increases the risk of cancer. Cigarette smoke is known to cause lung cancer. Although dietary factors like a low-fiber diet are suspected to alter cancer risk, their exact contribution is not clear.

What are the features of benign tumor cells? Select all that apply. a. They exhibit aneuploidy. b. They have migratory tendency. c. They have orderly growth patterns. d. They grow by hyperplastic expansion. e. They are encapsulated by fibrous connective tissue.

ANS: C, D, E Benign tumor cells have orderly growth patterns. They grow by hyperplastic expansion, causing the tissue to increase in size by increasing the number of cells. Growth may continue beyond an appropriate time or occur in the wrong place, but the growth rate is normal. They continue to make fibronectin and adhere to each other tightly. They are encapsulated by fibrous connective tissue which prevents them from migrating. Abnormal chromosomes or aneuploidy are common in cancer cells as they become more malignant. Benign cells have normal chromosomes. Cancer cells have a migratory tendency as they are not bound to each other with fibronectin.

While the nurse is obtaining the health history of a 75-year-old female patient, which of the following has the greatest implication for the development of cancer? a. Being a 75-year-old woman b. Family history of hypertension c. Cigarette smoking as a teenager d. Advancing age

ANS: D According to the American Cancer Society, 2007, the most important risk factor for cancer development is advancing age.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? a. A diagnosis of diabetes treated with insulin and diet b. An exercise regimen of jogging 3 miles four times a week c. A history of cardiac disease d. Advancing age

ANS: D Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases. Diabetes is not known to cause lung cancer. Regular exercise is not a risk factor for lung cancer, nor does having cardiac disease predispose a person to lung cancer.

The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention? a. Avoid asbestos. b. Wear sunscreen. c. Get the human papilloma virus (HPV) vaccine. d. Do not smoke cigarettes.

ANS: D All of these actions are part of cancer prevention; however, tobacco is the single most important source of preventable carcinogenesis. Asbestos may be found in older homes and buildings. Most schools have been through an asbestos abatement program so should not pose a risk. It would be important to share with teens who may be involved in the construction industry during the summer to be aware of asbestos risks. Although asbestos may present a risk for lung cancer, it is not a likely exposure for teens. Lifetime exposure to the sun and the use of tanning beds will increase the risk for cancer, but not as much as tobacco use. The HPV vaccine will decrease the risk for cervical cancer, but will not have as much of an impact on cancer prevention as avoiding tobacco.

A student nurse asks the nursing instructor what "apoptosis" means. What response by the instructor is best? a. Growth by cells enlarging b. Having the normal number of chromosomes c. Inhibition of cell growth d. Programmed cell death

ANS: D Apoptosis is programmed cell death. With this characteristic, organs and tissues function with cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition.

The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team? a. Temperature of 96.6° F b. Reports of joint pain c. Pink and dry oral mucosa d. Palpable lump in the client's axilla

ANS: D Clients taking immunosuppressive drugs to prevent rejection are at increased risk for the development of cancer; any lump should be reported to the physician. Fever should be reported to the physician, but this client's temperature is normal. It is not necessary to report joint pain to the transplant team; it is not a sign of rejection and is not a complication of transplant. A pink and dry oral mucosa may be a sign of dehydration, but it is not necessary to report this to the transplant team.

A client is diagnosed with familial polyposis. Which cancer may the client be at risk for developing in the future? a. Meningioma b. Breast cancer c. Gonadal cancer d. Colorectal cancer

ANS: D Clients with familial polyposis are at risk for developing colorectal cancer due to a genetic predisposition. Meningioma and gonadal cancer may eventually occur in clients with Turner's syndrome. Breast cancers are often inherited disorders or occur due to familial clustering.

The nurse is caring for a patient who received a bone marrow transplant 10 days ago. The nurse would monitor for which of the following clinical manifestations that could indicate a potentially life-threatening situation? a. Mucositis b. Confusion c. Depression d. Mild temperature elevation

ANS: D During the first 100 days after a bone marrow transplant, patients are at high risk for life-threatening infections. The earliest sign of infection in an immunosuppressed patient can be a mild fever. Mucositis, confusion, and depression are possible clinical manifestations but are representative of less life-threatening complications.

Which type of cancer has been associated with Down syndrome? a. Breast cancer b. Colorectal cancer c. Malignant melanoma d. Leukemia

ANS: D Leukemia is associated with Down syndrome and Turner syndrome. Breast cancer is often found clustered in families, not in association with Down syndrome. Colorectal cancer is associated with familial polyposis. Malignant melanoma is associated with familial clustering and sun exposure.

A 65-year-old client tells the nurse she does not have mammograms because there is no history of breast cancer in her family. What is the nurse's best response? a. "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you." b. "Performing breast self-examination monthly at home is sufficient screening for someone with your family history." c. "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." d. "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age."

ANS: D Only a small percentage of cancers, including breast cancers, are hereditary or familial. The far more critically important risk factor for breast cancer in women is advancing age. Although performance of monthly self-breast examination is good, for a woman of this age, it should be done in conjunction with a yearly mammogram.

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? a. "Cigarette smoking always causes lung cancer." b. "Taking multivitamins will prevent me from developing cancer." c. "If I have only one shot of whiskey a day, I probably will not develop cancer." d. "I need to report the pain going down my legs to my health care provider."

ANS: D Pain in the back of the legs could indicate prostate cancer in an older man. Cigarette smoking is implicated in causing lung cancer and other types of cancer, but it does not always cause cancer. Investigation is ongoing about the efficacy of vitamins A and C in cancer prevention. Limiting alcohol to one drink per day is only one preventive measure.

In caring for a patient following lobectomy for lung cancer, which of the following should the nurse include in the plan of care? a. Position the patient on the operative side only. b. Avoid administering narcotic pain medications. c. Keep the patient on strict bed rest. d. Instruct the patient to cough and deep breathe.

ANS: D Postoperative deep breathing and coughing is important to promote oxygenation and clearing of secretions. Pain medications will be given to lessen pain and allow for deep breathing and coughing. Strict bed rest is not instituted, because early ambulation will help lessen postoperative complications such as deep vein thrombosis. Prolonged lying on the operative side is avoided.

A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the client's chart that the cancer classification is TISN0M0. What does the nurse conclude about this client's cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report.

ANS: D TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis.

A client has a glioblastoma. The nurse begins to plan care for this client with which type of cancer? a. Liver b. Smooth muscle c. Fatty tissue d. Brain

ANS: D The prefix "glio-" is used when cancers of the brain are named. The prefix "hepato-" is included when cancers of the liver are named. The prefix "leiomyo-" is included when cancers of smooth muscle are named. The prefix "lipo-" is included when cancers of fat or adipose tissue are named.

Which statement about the process of malignant transformation is correct? a. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. b. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. c. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. d. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.

ANS: D The promotion phase consists of progression when the blood supply changes from diffusion to TAF.Insulin and estrogen increase cell division. If cell division is halted, mutation of genes does not lead to cancer development in the initiation phase. In the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latency phase occurs between initiation and tumor formation.

Which statement about carcinogenesis is accurate? a. An initiated cell will always become clinical cancer. b. Cancer becomes a health problem once it is 1 cm in size. c. Normal hormones and proteins do not promote cancer growth. d. Tumor cells need to develop their own blood supply.

ANS: D Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.