Pathophysiology Ch 7
A patient who is diagnosed with breast cancer asks the nurse if cancer cells ever die. Which of the following is the nurse's best response?
"Cancer cell differ from normal cells by being immortal and have an unlimited life span." Explanation: The best response for the nurse to make is to tell the patient the truth and that is cancer cells are immortal and can divide an infinite number of times, hence achieving immorality. The other responses are not therapeutic. Page 133-135
The nurse teaching a group of adolescent girls about Papanicolaou (Pap) testing determines that additional education is needed when one makes which of the following statements?
"It is a blood test." Explanation: The Pap test is commonly used as a screening test for cervical cancer. It consists of a microscipoic examiniation of a slide to assess for presence of abnormal cells. The Pap test can also be used to test nipple drainage, pleural and peritoneal fluids, and gastric washings. Page 130
A nursing student is caring for a patient who was recently diagnosed with breast cancer. Which of the following does the student explain what the doctor meant when the term "sentinel node" was mentioned?
"Sentinel node is used to describe the initial lymph node to which the primary tumor drains." Page 135
A client has been diagnosed with bladder cancer and is meeting with the interdisciplinary team to determine a course of treatment. The client's disease is believed to be treatable with targeted cancer therapies. What should the client be taught about this form of cancer treatment?
"This treatment has far less of an effect on healthy cells than chemotherapy or radiotherapy." Explanation: Targeted cancer therapy uses drugs that selectively attack malignant cells while leaving normal cells unharmed. This stands in sharp contrast to radiation therapy and chemotherapy, which have profound effects on healthy body cells. Targeted therapies do not guarantee quick results and there is no promise of future prevention. Targeted therapies address the activity of cancer cells directly rather than influencing the immune system Page 152
The nurse has provided an educational session with a 56-year-old man newly diagnosed with a benign tumor of the colon. The nurse knows that the client needs further teaching when he makes which remark?
"This tumor I have, will I die from it?" Explanation: Asking if his tumor will make him die shows lack of understanding of educational material he has been given. For unknown reasons, benign tumors have lost the ability to suppress the genetic program for cell proliferation but have retained the program for normal cell differentiation. They do not have the capacity to infiltrate, invade, or metastasize to distant sites. Page 136
An asymptomatic patient who is worried about developing breast cancer due to the fact that it runs in her family asks the nurse if she could have a mammogram to see if she has any lumps. The nurse informs the patient that a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. This means that at this point it measures approximately which of the following sizes?
1 cm Explanation: Using conventional radiographic methods, a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. At this point it is approximately 1 cm in size. A tumor that measures anything over 1cm including 3,4, and k5 cm would definitely be detectable using radiography. Page 134
Which of the following patients of primary care physician would not require extra screening for cancer?
A 38 year-old female with Down syndrome and congenital scoliosis Explanation: While a family history of cancer, immunosuppression and poor diet are all associated with cancer, congenital and chromosomal abnormalities are not noted to represent a increased risk. Page 153
A biopsy of a client's liver has been taken because there is suspicion that his lung cancer may have metastasized. The results confirm that there are cancerous cells in the client's liver and the oncologist has estimated a high growth fraction in the sample. The nurse should draw what implication from this finding?
A large proportion of the cells in the sample are actively dividing. Explanation: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. A high growth fraction represents a large proportion of growing cells, but does not necessarily mean that every cell is dividing. Stem cells would not be present in a sample from this location. Growth fraction does not imply a particular size of the cells. Page "?"
A 41 year old female with a family history has had a baseline mammogram. She states that she performs monthly self breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurses response is based on which of the following principles?
A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells. Explanation: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The doubling time is the length of time it takes for the total mass of cells in a tumor to double. Tumors do no stay in the M phase of the cell cycle. Undifferentiated cancer cells do come in various shapes/sizes but this has nothing to do with the detection of the tumor by palpation. Breast cysts are fluid filled sacs but are usually not cancerous. Page 147-148
A nurse caring for a child with Down syndrome understands that the child has an increased risk for which of the following illnesses?
Acute lymphoblastic leukemia Explanation: Children with Down syndrome have a higher risk for acute lymphoblastic leukemia and acute myelogenous leukema. Page 153-155
A 61 year-old male client is scheduled to begin chemotherapy for the treatment of his bone cancer shortly. Staff at the cancer center have educated the man and his wife about the goals, course and expectations of his treatment. Which of the following medications and treatments might the man anticipate needing during and after his course of treatment?
Antiemetics and packed red blood cell (PRBC) transfusions Explanation: Nausea and anemia are common side effects of chemotherapy, and may be addressed with antiemetics and PRBCs. There is no noted indication with chemotherapy for corticosteroids, antiplatelet aggregators, diuretics or SSRIs. Page 151
A patient whose mother and grandmother both have had cancer is at a higher risk for also developing the disease. Which of the following tumor suppressor genes are associated with genetic susceptibility to breast cancer? Select all that apply.
BRCA1 BRCA2 Explanation: Two tumor suppressor genes called BRCA1 and BRCA2 have been identified in genetic susceptibility to breast and ovarian cancer. Page 141
A patent is diagnosed with an adenoma. The nursing student identifies this as being which of the following?
Benign tumor of glandular epithelial tissue Explanation: An adenoma is a benign tumor of glandular epithelial tissue. An osteoma is a benign tumor of bone tissue. Page 130
A client is being treated for stomach cancer. The client is in considerable and constant pain, and the family is asking why. How does soft tissue cancer cause pain?
By compressing and eroding blood vessels, causing ulceration and necrosis, along with frank bleeding and sometimes hemorrhage. Explanation: The interruption of tissue integrity is responsible for the majority of pain in cancer. The physical compression is the cause of pain in bone cancer but not usually in soft tissue. There is no rearrangement of neurons that results in pain; rather, it results in loss of sensation. If the pain were to be caused by the flow of food into the stomach, it would only appear following a meal. Page 144
A nurse caring for a patient with progressive cancer notes that the patient has experienced significant loss of skeletal muscle and fat. The nurse documents this as being which of the following?
Cachexia Explanation: The nurse should document the loss of skeletal muscle and fat as cachexia. Page 145
The nurse in the oncology unit has just admitted a client with metastatic cancer. The client asks how cancer moves from one place to another in the body. What would the nurse answer?
Cancer cells enter the body's lymph system and thereby spread to other parts of the body. Explanation: Metastasis occurs by way of the lymph channels (i.e., lymphatic spread) and the blood vessels (i.e., hematogenic spread). In many types of cancer, the first evidence of disseminated disease is the presence of tumor cells in the lymph nodes that drain the tumor area. When metastasis occurs by way of the lymphatic channels, the tumor cells lodge first in the initial lymph node that receives drainage from the tumor site. Once in this lymph node, the cells may die because of the lack of a proper environment, grow into a discernible mass, or remain dormant for unknown reasons. If they survive and grow, the cancer cells may spread from more distant lymph nodes to the thoracic duct and then gain access to the blood vasculature. Because cancer cells have the ability to shed themselves from the original tumor, they are often found floating in the body fluids around the tumor. Cancer cells are not moved from one place to another by transporter cells. Cancer cells do not form a chain to grow to the new place in the body to form a new tumor. Page 135
Cancer cells have lost the ability to accurately communicate with other cells, and they do not have to be anchored to other cells to survive. How else are cancer cells different from normal cells? (Select all that apply.)
Cancer cells have an unlimited life span. Cancer cells have lost contact inhibition. Cancer cells are termed genetically unstable. Explanation: Cancer cells differ from normal cells by being immortal with an unlimited life span. Cancer cells often lose cell density-dependent inhibition, which is the cessation of growth after cells reach a particular density. This is sometimes referred to as contact inhibition because cells often stop growing when they come into contact with each other. Another characteristic of cancer cells is the ability to proliferate even in the absence of growth factors. Most cancer cells exhibit a characteristic called genetic instability that is often considered to be a hallmark of cancer. Page 133
The nurse is conducting a community class on the importance of early recognition of cancer. Screening mechanisms are available for which cancers? Select all that apply.
Cervical Prostate Breast Explanation: Cervical cancer is screened for with a Pap smear, while breast cancer can be screened with a self-examination monthly. Prostate cancer is screened with PSA testing. Currently, neither pancreatic nor lung cancers have a definitive screening mechanism. Page 147
Childhood cancers are often diagnosed late in the disease process because the signs and symptoms mimic other childhood diseases. However, more children are surviving childhood cancer. Survivors may face which late-term effects of their cancer treatments? (Select all that apply.)
Cognitive dysfunction and hormonal dysfunction Impaired growth and second malignancies Cardiomyopathy and pulmonary fibrosis Explanation: With improvement in treatment methods, the number of children who survive childhood cancer is continuing to increase. As these children approach adulthood, there is continued concern that the life-saving therapy they received during childhood may produce late effects, such as impaired growth, cognitive dysfunction, hormonal dysfunction, cardiomyopathy, pulmonary fibrosis, and risk for second malignancies. Liver failure is not viewed as a late effect of childhood cancer therapy. Page 153-154
A client diagnosed with breast cancer is scheduled for surgery. The surgical procedure will include identification of the sentinel node. The data obtained from the procedure will:
Determine the extent of the disease Explanation: The term sentinel node is used to describe the initial lymph node to which the primary tumor drains. Because the initial metastasis in breast cancer is almost always lymphatic, lymphatic spread and, therefore, extent of disease may be determined through lymphatic mapping and sentinel lymph node biopsy. It will not determine cause, infection, or cause drainage. Page 135
A nurse is teaching a group of clients about causes/risk factors for cancer, which include: Select all that apply.
Environment Heredity Genetics Age Explanation: The cause or causes of cancer can be viewed from two perspectives: (1) the genetic and molecular mechanisms that characterize the transformation of normal cells into cancer cells and (2) the external and more contextual factors such as age, heredity, and environmental agents that contribute to its development and progression. Financial status does not influence risk factors. Page 137
Unbeknownst to her or her care team, a 51 year-old woman's breast cancer has an etiology rooted in the fact that tumor suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins and neoplasia has resulted. What process has accounted for the woman's cancer?
Epigenetic mechanisms Explanation: Epigenetic mechanisms may "silence" genes, such as tumor suppressor genes, so that even though the gene is present, it is not expressed and a cancer suppressing protein is not made. This process does not involve defects in DNA repair or chromosomal translocation and while it may form a half of the "two-hit" hypothesis, this is not synonymous with epigenetic mechanisms. Page 138
Select the option that best identifies how adult cancers differ in origin from childhood cancers. Adult cancers originate from:
Epithelial cells Explanation: Adult cancers are typically of epithelial cell origin, while childhood cancers involve the hematopoietic system, nervous system, soft tissues, bone, and kidneys. Childhood cancers have a more primitive (embryonic) appearance. Page 130
Therapeutic radiation can be delivered by which methods? (Select all that apply.)
External beam Brachytherapy Systemic therapy Explanation: Therapeutic radiation can be delivered in one of three ways: external beam, where beams generated by a linear accelerator at a distance and aimed at the client's tumor; brachytherapy, where a sealed radioactive source is placed close to or directly in the tumor site; and systemic therapy, in which radioisotopes with a short half-life are given by mouth or injected into the tumor site. Light therapy is not a form a radiation therapy. Page 150
A nursing student says the following to her instructor: " Malignant neoplasms are more well-differentiated than benign tumors." Which of the following is the answer?
False Explanation: Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation. Page 129-131
A patient with malignant melanoma has been prescribed alpha interferon, a biologic response modifier. Since this drug prolongs the cell cycle, increasing the percentage of cells in the G0 phase, and stimulates NK cells and T-lymphocyte killer cells, the nurse can anticipate that they may experience which of the following common side effects?
Fever, chills, and fatigue. Explanation: Interferon is a biologic response modifier that changes a person's own immune response to cancer. This medication is given by injection, usually every other day. Because of stimulation of the body's natural immune response, the patient experiences extreme flu-like symptoms. Page 147
A nurse is studying about benign cancers and recognizes which tumors are classified as benign? Select all that apply.
Fibroma Lymphangioma Explanation: A fibroma and lyphangioma are both benign while a glioblastoma, multiple myeloma, and meningeal sarcoma are malignant in nature Page 129-132
While studying cancer, a nursing student learns that most cancer-associated genes can be classified into which broad categories? Select all that apply.
Gene overactivity Gene underactivity Explanation: Most cancer-associated genes can be classified into two broad categories based on whether the gene overactivity or underactivity increases the risk for cancer. Page 137-140
A nurse on the oncology floor reads a client's chart and sees that the client was treated for an adenocarcinoma. What type of tissue composes this tumor?
Glandular epithelium Explanation: The term "adenocarcinoma" denotes a malignancy of the glandular epithelium. CNS cancers usually begin with "neuro-" and there is no particular term used to denote a stem cell cancer. There are varied terms used to describe cancers of the connective tissue, depending on the tissue type. Page 130
A client has undergone a screening colonoscopy. The doctor removed several polyps that were sent to pathology and identified as benign. Select the best explanation of a polyp.
Growth that projects from a mucosal surface Explanation: A polyp is a growth that projects from a mucosal surface, such as the intestine. Papillomas are benign microscopic or macroscopic fingerlike projections that grow on any surface. A benign epithelial neoplasm of glandular tissue is called an adenoma, and a benign tumor arising in fibrous tissue is called a fibroma. Page 130
A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?
Heart failure resulting from childhood chemotherapy Explanation: The patient's symptoms resemble those of congestive heart failure. The anthracyclines, such as doxorubicin and daunorubicin, are associated with risk for developing cardiomyopathy and heart failure. Page 155
A nurse doing a presentation on cancer to a local community group identifies which factors to be high-risk and associated with cancer development? Select all that apply.
Heredity Hormonal factors Environmental agents Immunologic mechanisms Explanation: Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents. Obesity has also been suggested to a factor. Page 144
It is well known that cancer is not a single disease. It follows then that cancer does not have a single cause. It seems more likely that the occurrence of cancer is triggered by the interactions of multiple risk factors. What are some identified risk factors for cancer?
Hormonal factors, chemicals, and immunologic mechanisms Explanation: Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic (cancer-producing) agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been interest in obesity and type 2 diabetes mellitus as risk factors for a number of cancers. Body type, age, and color of skin have not been identified as risk factors for cancer. Page 144
A client received a liver transplant and is now taking immunosuppressant medication. The client has been told that a potential side effect of the therapy is the development of cancer. Select the option that best supports this information.
Immune surveillance hypothesis The immune surveillance hypothesis suggests that the development of cancer might be associated with impairment or decline in the surveillance capacity of the immune system. Increases in cancer incidence have been observed in people with immunodeficiency diseases and in those with organ transplants who are receiving immunosuppressant drugs. The other options will not cause immunosuppression. Page 141
The nursing student studying about cancer growth correctly identifies "cell proliferation" to mean which of the following?
Increasing cell numbers by mitotic cell division Explanation: Cell proliferation is the process of increasing cell numbers by mitotic cell division. Mitosis cannot start until DNA is properly replicated. Apoptosis is a form of programmed cell death that eliminates senescent and some types of injured cells. Page 129-130
A client has been diagnosed with cancer that was a result of dysfunctional apoptosis. The health care provider explains the process to the multidisciplinary client care team. Select the best explanation.
It allows for DNA-damaged cells to survive. Explanation: Apoptosis is considered a normal cellular response to DNA damage; loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive. Page 133
Which of the following is the primary advantage of targeted cancer therapy?
It uses drugs that selectively attack malignant cancer cells. Explanation: Targeted cancer therapy uses drugs that selectively attack malignant cells without causing harm to normal cells. The remaining options are not necessarily true. Page 152
An oncology nurse recognizes that the cluster of differentiation (CD) antigen is present on leukocytes and is the tumor marker used in which of the following cancers? Select all that apply.
Leukemia Lymphoma Explanation: CD antigens are present on leukocytes and are used to determine the type and level of differentiation of leukocytes involved in different types of leukemia and lymphoma. Page 147-148
A nursing student while studying cancer cells identifies which of the following to be the best definition of anaplasia?
Loss of cell differentiation in cancerous tissue Explanation: The term "anaplasia" is the loss of cell differentiation in cancerous tissue. Rapid proliferation of cancer cells refers to a rapid increase in number of cells, while decreased proliferation is a decrease in the growth or decrease in the number of cells. An increase in cell differentiation refers to the process by which a less specialized cell becomes a more specialized cell type. This is not what happens during anaplasia. Page 132
Which of the following cancers is the leading cause of cancer death?
Lung Explanation: Lung cancer is the leading cause of cancer deaths of men and women in the United States. Page 129
In some cancers, the presenting factor is an effusion, or fluid, in the pleural, pericardial, or peritoneal spaces. Research has found that almost 50% of undiagnosed effusions in people not known to have cancer turn out to be malignant. Which cancers are often found because of effusions?
Lung and ovarian cancers Explanation: Lung cancers, breast cancers, and lymphomas account for about 75% of malignant pleural effusions. Complaints of abdominal discomfort, swelling, and a feeling of heaviness and an increase in abdominal girth, which reflect the presence of peritoneal effusions or ascites, are the most common presenting symptoms in ovarian cancer, occurring in up to 65% of women with the disease. Page 144
The nursing student who is studying about cancer correctly identifies which of the following to be the leading cause of death in both men and women?
Lung cancer Explanation: The leading cause of death in both men and women is lung cancer. Breast cancer leads death in women, whereas prostate cancer is the leading cause of death in men. Page 129
A nursing instructor sees the need for further instruction when one student makes which of the following statements concerning cancer?
Malignant neoplasms tend to grow slowly. Explanation: Malignant neoplasms, which invade and destroy nearby tissue and spread to other parts of the body, tend to grow rapidly and spread widely and have the potential to cause death. Page 130
A nurse who is caring for a patient with liposarcoma plans care for a patient with which of the following?
Malignant tumor of adipose tissue Explanation: The nurse should plan care for a patient with a malignant tumor of adipose tissue. Page 131
Cancer prognosis has improved most dramatically when treatment plans include which of the following?
Multiple types of treatment Explanation: Treamtent plans that use more than one type of therapy, ofen in combination, are providing cures for a number of cancers that a few decades ago had a poor prognosis, and are increasing the life expectance in other types of cancer. The remaining options can be components of a multi-pronged treatment plan. Page 149
Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues?
Neoplasm Explanation: An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm. A transformation occurs when a cell has become cancerous. A mutation is an alteration in the DNA that may or may not result in a transformation. An insertion is a type of mutation. Page 136
Because an adolescent has revealed a history of childhood cancer, the nurse should include in the plan of care an assessment for which of the following late therapy sequelae? Select all that apply.
Neurologic dysfunction Impaired growth Explanation: The nurse should include assessment for late therapy sequelae including impaired growth, neurologic dysfunction, pulmonary fibrosis, hormonal dysfunction, cardiomyopathy, and risk for secondary malignancies. Page 153
A nursing student who describes cell characteristics that include regulated growth, genetic stability, limited life span, and growth factor dependence is talking about which of the following types of cells?
Normal cells Explanation: Normal cells have regulated growth, high differentiation, genetic stability, growth factor dependence, high density dependence, and cell-to-cell adhesion. Page 133
The nurse is conducting cancer risk assessment at a community health fair. A patient states that he smokes and drinks considerable amounts of alcohol. The nurse concludes that the patient is at risk for which of the following types of cancer? Select all that apply.
Oral Laryngeal Esophageal Explanation: Smoking and drinking considerable amounts of alcohol increases a patient's risk for cancer of the oral cavity, larynx, and esophagus. Page 147
A big difference in the treatment of childhood cancer as opposed to adult cancer is that chemotherapy is the most widely used treatment therapy for childhood cancer. What is the reason for this?
Pediatric tumors are more responsive to chemotherapy than adult cancers. Explanation: Chemotherapy is more widely used in the treatment of children with cancer than in adults because children better tolerate the acute adverse effects, and in general, pediatric tumors are responsive to chemotherapy than adult cancers. Children are very adaptable and tolerate more forms of cancer treatment than adults do. Children do complain about the nausea and vomiting chemotherapy can cause, just like adults do, and they do not like losing their hair, just like adults. Page 154
A nurse assessing a client with lung cancer notes that the patient presents with shortness of breath, chest pain, and a cough. The nurse anticipates testing for which complication assoicated with lung cancer?
Plueral effusion Explanation: The nurse should anticipate testing for pleural effusion as lung cancers, breast cancers and lymphomas account for 76% of malign pleural effusions. Presenting symptoms include chest pain, shortness of breath, and coughing. Page 144
One group of chemical carcinogens is called indirect-reacting agents. Another term for these agents is procarcinogens, which become active only after metabolic conversion. One of the most potent procarcinogens is a group of dietary carcinogens called:
Polycyclic aromatic hydrocarbons Explanation: Most known dietary carcinogens either occur naturally in plants (e.g., aflatoxins) or are produced during food preparation. Among the most potent of the procarcinogens are the polycyclic aromatic hydrocarbons. The polycyclic aromatic hydrocarbons are of particular interest because they are produced from animal fat in the process of charcoal-broiling meats and are present in smoked meats and fish. They also are produced in the combustion of tobacco and are present in cigarette smoke. Initiators is another term for procarcinogens. Diethylstilbestrol was a drug that was widely used in the United States from the mid-1940s to 1970 to prevent miscarriages. Page 142
The family of a 68 year-old man who is in the end stages of small cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which phenomena best accounts for the client's anorexia and cachexia?
Products of the tumor itself as well as a hypermetabolic state cause cachexia. Explanation: The mechanisms of anorexia-cachexia in cancer patients are multifactorial, involving factors that include a hypermetabolic state and the production of specific cytokines and catabolic factors by the tumor. Glucose metabolism itself is not noted to be affected by tumors and muscle mass is lost in large amounts. The phenomenon is not necessarily attributable to the decrease in food intake. Page 145
While studying cancer, nursing students learn about the process by which cancer-causing agents cause normal cells to become cancerous. This process is a multi-step mechanism that can be divided into three stages, which include which of the following? Select all that apply.
Promotion Progression Initiation Explanation: The process by which carcinogenic agents cause normal cells to become cancerous is a mechanism that are divided into three stages: initiation, promotion, and progression. Page 147-149
The oncologist has assessed a client diagnosed with cancer and determined that radiation therapy is the best course of treatment. The therapy will be most effective for:
Radiosensitive tumors that are fast growing Explanation: The therapeutic effects of radiation therapy derive from the fact that the rapidly proliferating and poorly differentiated cells of a cancerous tumor are more likely to be injured by radiation therapy than those that are the more slowly proliferating cells of normal tissue. Radiation works better on tumors that are fast growing, with less metastasis, and that are well oxygenated. Page 149
The nurse is explaining to a client the adverse side effects of cancer therapies. Which target of both chemotherapy and radiation treatment accounts for the adverse as well as therapeutic effects of these treatments?
Rapidly proliferating cells Explanation: Chemotherapy and radiation treatment both preferentially affect rapidly proliferating cells, which includes some normal body cells, such as epithelial and hair-follicle cells, as well as cancer cells. These effects of chemotherapy and radiation therapy do not result from the fact that they affect hormones, blood vessels, or cell receptors. Page 150
A patient who has recently attended a talk on healthy tips for preventing cancer identifies which foods/compounds to be carcinogenic in humans? Select all that apply.
Smoked foods Nickel compounds Cigarette smoke Explanation: There are many agents known to be carcinogenic to humans including soot, tar, cigarette smoke, arsenic compounds, nickel compounds, and smoked foods among many others. Page 142
Blood-borne cancerous cells have recent spread from a woman's primary pancreas tumor to her bones. Which components of the woman's immune system are likely to be directly involved in the attempt to eradicate the potential metastasis? Select all that apply.
T lymphocytes Macrophages Natural killer (NK) cells B lymphocyte cells Explanation: During the S phase, DNA synthesis occurs, causing 2 separate sets of chromosomes to develop. Antimetabolites can cause abnormal timing of DNA synthesis. Because of their S-phase specificity, the antimetabolites are more effective when given as a prolonged infusion. Page 139
A 42-year-old female client with breast cancer has a tumor that is minimal in size and extension, has minimal regional lymph nodes involved, and has no distant metastasis. Using the TNM system the tumor is staged as:
T1, N1, and M0 Explanation: This client has T1—minimal size and extension of the tumor; N1—minimal regional lymph node involvement; and M0—no distant metastasis. Page 149
Which of the following characteristics could apply to healthy somatic cells rather than cancerous cells?
The cells are unable to proliferate except by mitotic division. Explanation: Mitotic division is the normal method of division that exists in the body. High rates of mutation, reduced adhesion and loss of anchorage dependence are associated with cancer cells. Page 138
A client has undergone extensive diagnostic testing and has been diagnosed with breast cancer staged as T3, N0, M0. What conclusion can the nurse draw from the staging of the client's breast cancer?
The client has a sizable tumour but there is no lymphatic involvement. Explanation: This client's staging indicates a tumour of significant size but no evidence of lymph node involvement or metastasis. The "3" in "T3" does not denote a specific size of 3 mm, however. Metastasis is not currently present, but this does not mean that it is not a future possibility if left untreated. Page 149
A 77 year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?
The portal circulatory system brings venous blood from the GI tract into the liver. Explanation:Portal circulation brings venous blood into the portal vein of the liver, facilitating hematologic spread. The parenchyma of the liver possesses no particular susceptibility to cancer and hepatic tissue does not share traits of cancerous cells such as low contact inhibition or lack of anchorage dependence. Page 147-148
A cancer patient has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S phase of the cell cycle. When teaching this patient, the nurse explains that during the S phase of the cell cycle:
There will be a greater number of cancers that are epithelial in origin. Explanation: Epithelial cancers are more common in adults, while "blastomas" and cancers of the hematopoietic system such as leukemia are more common in children. Page 153-154
An oncologic client is scheduled to begin antiangiogenesis therapy. What is the goal of this type of treatment?
To limit the size of the tumour by limiting its ability to recruit blood vessels. Explanation: Antiangiogenesis therapy is designed to inhibit the growth of new blood vessels, thus limiting the availability of blood to the growing tumour, resulting in decreased oxygen delivery and decreased ATP synthesis. There are no genetic effects on the tumour promoters or genetics. Page 140
The nursing student studying about cancer says the following: "A neoplasm, benign or malignant, represents a new growth." This statement is considered to be which of the following?
True Explanation: A neoplasm, benign or malignant, represents new growth. However, benign and malignant tumors differ in terms of cell characteristics, manner of growth, rate of growth, potential for metastasis, ability to produce generalized effects, tendency to cause tissue destruction, and capacity to cause death. Page 129
A young patient who received radiation treatment to decrease the size of his tonsils is at a high risk for developing thyroid cancer. Which time frame is considered the latency period for this cancer?
Up to 35 years Explanation: The latency period for the development of thyroid cancer in infants and small children who received radiation to the head and neck for treatments is as long as 35 years. Page 140-142
A client has been diagnosed with cancer and will begin aggressive treatment. The client's course of treatment includes drug therapies that affect cyclins and cyclin-dependent kinases (CDKs). This drug will achieve a therapeutic effect by:
affecting the progression of cells through the process of cell division. Explanation: The cyclins are a family of proteins that control the entry and progression of cells through the cell cycle. Manipulation of cyclins, CDKs, and CDK inhibitors serves as the basis for development of newer forms of drug therapy that can be used in cancer treatment. These types of drugs would not cause cell atrophy and they do not have a direct effect on the role of stem cells. Page 137
A client's tissue biopsy reveals the presence of cells that appear to have abnormalities in shape and size. Carcinoma is suspected because these cells possess the characteristics of:
loss of differentiation. Explanation: The deviation from normal patterns of differentiation is a characteristics of cancer cells. Angiogenesis is also associated with malignancy, but this does not directly account for abnormalities in size and shape. Cohesiveness, adhesion, and cell density--dependent inhibition are characteristics of normal cells. Page 129
