Unit 2
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs, "more fluids in my vein?" The nurse responds:
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." Explanation: Large-volume paracentesis (removal of 5 L or more of ascitic fluid) may be done in persons with massive ascites and pulmonary compromise. Because the removal of fluid produces a decrease in vascular volume along with increased plasma renin activity and aldosterone-mediated sodium and water reabsorption by the kidneys, a volume expander such as albumin usually is administered to maintain the effective circulating volume. The other distractors are all incorrect.
A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breastfed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month--now it seems like she has been sick constantly. Why?" How should the physician respond?
"An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature." Explanation: The infant's immune system is not yet mature. Passive immunity is immunity transferred from mother to fetus before birth. After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature.
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." -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.
The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?
"Gallstones have developed, which are typically composed of cholesterol." Explanation: Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. It is most common in women, multiple pregnancies, those taking oral contraceptives or those who are obese.
A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process". Which of the following responses listed below best conveys an aspect of the role of CD4+ helper T cells in immunity?
"Helper T cells play a major role in stimulating and regulating the whole process." Explanation: Helper T cells are central to the regulation, proliferation and stimulation of the immune system. They do not play a central role in antigen presentation or early hematopoiesis, however. Their absence would not result in incorrect antibody production, but rather insufficient or absent immune response.
The nurse is teaching a group of college students about reducing the risk of HIV transmission during sexual relations. The nurse makes which of the following appropriate teaching points?
"If a person has a sexually transmitted disease (STD), there is an increased risk for HIV infection."
A nurse is teaching a new mother diagnosed with HIV about the transfer of the infection to her newborn. The mother begins to cry and states, "It's too late, the lab tests on my baby are already positive for HIV." How should the nurse respond?
"Just because the test is positive for HIV does not mean your baby is infected with the virus." Explanation: Because of maternal transfer of IgG antibodies to the fetus, an infant born to a mother infected with HIV has a positive HIV antibody test result although the child may not be infected with the virus
A pregnant client who has HIV asks the nurse if her baby will have the disease. The best response would be:
"The baby will test positive for the HIV antibody test result, although the child may not necessarily be infected with the virus."
A male patient has just been diagnosed with esophageal cancer. He knew he was losing weight and fatigued most days, but he just attributed it to aging and working. The physician recommends chemotherapy and irradiation. However, the cancer has already metastasized. The patient asks the nurse what he can expect if he agrees to the treatments. The nurse responds:
"The therapies may shrink the cancer in an effort to increase survival of the cancer."
An 8-year-old boy has been diagnosed with acute lymphatic leukemia (ALL). His treatment plan includes placement of an implanted central venous catheter and multiple administrations of chemotherapy. The client says "NO! I don't want to be struck with needles all the time." What can the nurse say to decrease his anxiety? How would the nurse explain the way chemotherapy works to the boy's parents?
"To make it better for you, the doctor is going to put a tube just under your skin that the nurses can put your medication in, so they won't have to stick you in the hands and arms so many times. You will still get stuck by a needle, but it will not be as painful as trying to start an IV in your arms." Since the clients cancers found in his blood and bone marrow, surgery cannot be used to cure it. Chemotherapy is the primary treatment for most hematologic and some solid tumors. Chemotherapy is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites. Cancer chemotherapeutic drugs exert their effects through several mechanisms. At the cellular level, they exert their lethal action by targeting processes that prevent cell growth and replication. These mechanisms include disrupting the production of essential enzymes, inhibiting DNA, RNA, and protein synthesis, and preventing cell reproduction.
A patient has just been diagnosed with pernicious anemia. The patient asks the nurse why their body is not able to absorb vitamin B12. The nurse responds:
"Your stomach is not secreting a substance known as intrinsic factor which is needed to absorb vitamin B12."
Compare and contrast benign tumors and malignant tumors.
1) Benign: Grow slowly/ Well-defined capsule/ Well-differentiated/ Low mitotic index/ Does not metastasize 2) Malignant: Grow rapidly/ Not encapsulated/ Poorly differentiated/ high mitotic index/ Metastasis
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?
1cm
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.
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. - Following a mammogram, a needle biopsy is ordered. What is the purpose of a biopsy?
A needle will be inserted into the tumor and few cells are withdrawn. The purpose is to test those cells for cancer characteristics, such as loss of differentiation (a high degree of anaplasia). Other cancer cell characteristics are: changes in growth properties, loss of contact inhibition, anchorage independence, and telomeres are maintained.
A middle school student is scheduled to receive booster immunizations and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse's response?
A secondary response causes a sharp rise in antibody levels. Explanation: Booster immunizations take advantage of the increase in antibodies that accompanies a repeat exposure. The primary immune response cannot be repeated, and antibodies survive beyond several months. Antigen receptors on CD4+ cells do not require multiple exposures.
Define jaundice
Abnormally high accumulation of bilirubin in the blood
What is hypothesized to be a cause of inflammatory bowel disease (ulcerative colitis and Crohn disease)?
According to the currently accepted hypothesis, this normal state of homeostasis is disrupted in inflammatory bowel disease leading to unregulated and exaggerated immune responses against bacteria in the normal intestinal flora of genetically susceptible individuals. Thus, as in many other autoimmune disorders, the pathogenesis of Crohn disease and ulcerative colitis involves a failure of immune regulation, genetic predisposition, and an environmental trigger, especially microbial flora.
A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is in the client's medications?
Acetaminophen Explanation: The drug most commonly involved is acetaminophen, with half the cases reported to be unintentional overdoses. Unintentional overdoses may occur when people unknowingly take several over-the-counter preparations that contain acetaminophen (e.g., an acetaminophen containing cold preparation and acetaminophen pain medication). Phenylephrine is a nasal decongestant often combined with acetaminophen for relief of cold symptoms.
The nurse is administering a measles, mumps, and rubella (MMR) vaccination to a pediatric client. When the nurse explains immunity to the mother, which type of immunity will she explain that this vaccination provides?
Active artificial immunity Explanation: Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination (artificial means) or from environmental exposure (natural means). It is called active immunity because it requires the host's own immune system to develop an immunological response. The process by which active immunity is acquired through the administration of a vaccine is termed immunization. An acquired immune response can improve on repeated exposures to an injected antigen (booster vaccines) or a natural infection.
Compare and contrast active versus passive immunity.
Active immunity is acquired through immunization or actually having a disease. It is active as it depends on a response to the antigen by the person's immune system. Because of memory, the immune system usually is able to react within hours to subsequent exposure to the same agent because of the presence of memory B and T lymphocytes and circulating antibodies. Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies form its mother in utero and through a mother's breast milk.
A client is brought to the physician's office with a raised red macular rash on the trunk and arms accompanied by a fever. A diagnosis of measles is made. Which type of immunity does this disease process provide?
Active natural immunity Explanation: Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination (artificial means) or from environmental exposure (natural means). It is called active immunity because it requires the host's own immune system to develop an immunological response.
_____ immunity is the second major immune defense.
Adaptive
A client with history of alcohol abuse is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder?
Alcoholic hepatitis Explanation: Fatty liver occurs when there is an accumulation of fat in the liver cells. The liver enlarges and becomes yellow. The fatty changes are reversible when alcohol intake stops. Alcoholic hepatitis is the next stage of liver disease after fatty liver. It is common when there is a sudden increase in alcohol intake and has a mortality rate of approximately 34 percent. The liver becomes inflamed and necrosis occurs. If the client survives and continues to use alcohol, alcoholic hepatitis develops into alcoholic cirrhosis. The liver develops fine, uniform nodules on the surface. As the disease progresses, the nodules become larger, blood flow is obstructed resulting in portal hypertension, extrahepatic portosystemic shunts, and cholestasis. Gallbladder cancer occurs insidiously and have similar signs/symptoms as cholelithiasis.
A client presents to the Urgent Care with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy. The reaction may be classified as:
Allergic contact dermatitis
Type I hypersensitivity reactions to antigens is referred to as ______.
Allergic reactions
How do the cells of the immune system communicate with each other?
Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short-acting soluble molecules called cytokines. One type of cytokine, chemokines, direct leukocyte movement and migration, and another group of cytokines, the colony-stimulating factors, promote the proliferation and differentiation of bone marrow progenitor cells. Chemokines give the cells of the immune system the ability to act systemically as one.
When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?
Amylase and lipase Explanation: Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.
What are the factors that lead to the development of ascites?
An increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver, salt and water retention y the kidney, and decreased colloidal osmotic pressure due to impaired synthesis of albumin by the liver lead to the development of ascites. Diminished blood volume (i.e. underfill theory) and excessive blood volume (i.e. overfill theory) have been used to explain the increased salt and water retention by the kidney.
Passive immunity is immunity that is transferred from another source and lasts only weeks to months. What is an example of passive immunity?
An injection of gamma-globulin. Passive immunity also can be artificially provided by the transfer of antibodies produced by other people or animals. Some protection against infection of hyperimmune serum, which contains high concentrations of antibodies for a specific disease, or immune serum, or gamma-globulin, which contains a pool of antibodies from many individuals providing protection against many infectious agents. Immunizations and allergy shots are examples of active immunity. Exposure to poison ivy can be cause of a hypersensitivity reaction it is not immunity.
____ is a systemic life-threatening hypersensitivity reaction characterized by widespread edema, vascular shock secondary to vasodilation, and difficulty breathing.
Anaphylaxis
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. What are some other clinical manifestations of cancer that Mrs. B. could experience if the cancer continues to progress?
Anemia, fatigue or weakness, anorexia/cachexia, pain/bone pain, hair loss, disfigurement, depression, end of life concerns/family concerns.
_____ represents a loss of appetite
Anorexia
A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of:
Antidiuretic hormone (ADH) and oxytocin Explanation: The posterior pituitary secretes ADH and oxytocin/vasopressin, while the anterior pituitary secretes the hormones listed in the other choices.
Substances foreign to the host that can stimulate an immune response are known as:
Antigens
____ are substances foreign to the host that can stimulate an immune response.
Antigens
_____ occurs when the amount of fluid in the peritoneal cavity is increased
Ascites
An elderly patient presents with loose mucousy stools. The nurse suspects the patient has Clostridium difficile. What is a priority assessment for the nurse? a) Ask the patient about his or her antibiotic use. b) Ask the patient about the foods he or she has consumed. c) Ask the patient about his or her normal bowel pattern. d) Ask the patient about his or her fluid intake.
Ask the patient about his or her antibiotic use. The diagnosis of C. difficile-associated diarrhea requires a careful history, with particular emphasis on antibiotic use.
Select the statement that best describes autoimmune disease.
Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmunity results from a failure of tolerance. Autoimmune disorders may be triggered by environmental stimuli, such as infections, in a genetically predisposed individual. Overuse of antibiotics, however, does not lead to autoimmune diseases.
Select the type of lymphocyte that matures in the bone marrow.
B lymphocytes Explanation: B lymphocytes mature in the bone marrow and are essential for humoral or antibody-mediated immunity. The T lymphocytes mature in the thymus. Macrophages are part of the monocytic phagocyte system and are in almost all tissues and are the mature form of monocytes. Cytotoxic T cells are involved in cell-mediated immunity
____ cells and _____ cells are the only cells in the body capable of specifically recognizing different antigenic determinants of microbial agents and other pathogens.
B, T
Define Gastroesophageal reflux
Backward movement of gastric contents into the esophagus
_____ do not usually cause death unless the location interferes with vital organs function.
Benign tumors
List some of the common methods used for diagnosing cancer.
Blood tests for tumor markers, cytologic studies and tissue biopsy, and endoscopic examinations, ultrasound, X-ray studies, MRI, CT, and positron-emission tomography
Cell-mediated immunity is involved in resistance to infectious diseases caused by bacteria and some viruses. It is also involved in cell-mediate hypersensitivity reactions. Which of these does not cause a cell-mediated hypersensitivity reaction?
Blood transfusion. Activation of macrophages ensures enhanced phagocytic, metabolic, and enzymatic potential, resulting in more efficient destruction of infected cells. This type of defense is important against intracellular pathogens such as Mycobacterium species and Listeria monocytogenes. Contact dermatitis due to a poison ivy reaction or sensitivity to dyes is an example of delayed of cell-mediated hypersensitivity caused by hapten-carrier complexes. Blood transfusions by hapten-carrier complexes.
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.
The human immunodeficiency virus (HIV) acts on which of the following types of cells?
CD4+ T lymphocytes
The ____ serves as a master regulator for the immune system.
CD4+ helper T cell (TH)
T cells can be functionally divided into two subtypes: ____ and ____ T cells.
CD4+ helper, CD8+ cytotoxic
_____ of the colon is one of the feared complications of ulcerative colitis.
Cancer
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.
Explain how a diminished immune system may play a role in carcinogenesis.
Cancer cells express abnormal cell surface proteins. Normally, the immune system recognizes these abnormal proteins and destroys the cancerous cell. With a compromised immune system, these abnormalities are missed and allowed to persist in the body.
____ immunity is mediated by specific T lymphocytes and defends against intracellular microbes such as viruses
Cell-mediated
___ are cytokines that stimulate the migration and activation of immune and inflammatory cells.
Chemokines
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. What are two educational points to discuss with Mrs. B about chemotherapy?
Chemotherapy is usually given in a 2-3 drug combination through an IV line that is inserted into your chest (this is called a central IV). Chemotherapy also targets rapidly dividing cells and you will require several treatments in order to ensure the most cancer cells are killed. While chemotherapy kills cancer cells, it also kills other rapidly dividing normal cells such as hair follicles, and losing you hair may occur with this treatment. Each person feels differently about this, so the nurse will need to explore Mrs. B's feelings before discussing options such as scarves, hats of wigs. Chemotherapy may have other effects such as anemia or N/V. The cancer treatment team will assist Mrs. B in handling these effects, most commonly with medications.
____ diarrhea is often associated with conditions such as inflammatory bowel disease, irritable bowel syndrome, malabsorption syndrome, endocrine disorders, or radiation colitis.
Chronic
What is the relationship between Helicobacter pylori infection and the development of stomach cancer?
Chronic infection with Helicobacter pylori appears to serve as a cofactor in some types of gastric carcinomas. The bacterial infection causes gastritis, followed by atrophy, intestinal metaplasia, and carcinoma. This sequence of cellular events depends on both the presence of the bacterial proteins and the host immune response; the latter being influenced by the host genetic background. However, most people with Helicobacter pylori infection will not develop gastric cancer, and not all H. pylori infections increase the risk of gastric cancer, suggesting that other factors must be involved.
____ represents the end stage of chronic liver disease in which much of the functional liver tissue has been replaced by fibrous tissue.
Cirrhosis
What is cirrhosis of the liver?
Cirrhosis is characterized by diffuse fibrosis and conversion of normal liver architecture into nodules containing proliferating hepatocytes encircled by fibrosis. The formation of nodules represents a balance between regenerative activity and constrictive scarring. The fibrous tissue that replaces normally functioning liver tissue forms constrictive bands that disrupt flow in the vascular channels and biliary duct systems of the liver. The disruption of vascular channels predisposes to portal hypertension and is complications; obstruction of biliary channels and exposure to the destructive effects of bile stasis; and loss of liver cells, leading to liver failure.
A lactation nurse visits a new mother after delivery of her first child and encourages the mother to breastfeed her infant, even for a short time. Which statement made by the nurse correctly explains the importance of breastfeeding?
Colostrum will provide the infant with passive immunity for several months to diseases to which the mother has immunity. Explanation: After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature. IgA is primarily a secretory Ig that is found in saliva, tears, colostrum (i.e., first milk of a nursing mother), and bronchial, gastrointestinal, prostatic, and vaginal secretions. Its primary function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and bacteria to epithelial cells
Type III hypersensitivity reaction
Complement-mediated immune disorders
____ can be defined as the infrequent and/or difficult passage of stools.
Constipation
The nurse is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the nurse assess? Select all that apply.
Constipation Gastrointestinal bleeding High colonic pH Explanation: Ammonia is produced in the colon by the bacterial degradation of proteins and amino acids, therefore more ammonia will be produced when the bacteria has access to either a greater protein load (such as when a person has bleeding in the gastrointestinal tract) or prolonged contact with colonic contents such as occurs with constipation. Normally, ammonia diffuses into the portal circulation and is transported to the liver, where it is converted to urea before entering the general circulation and then excreted via urine. When the liver is unable to convert ammonia to urea, ammonia accumulates and affects neurologic functioning. Using lactulose to create a more acidic colonic environment (low pH) is one treatment for hepatic encephalopathy. Therefore, a high colonic pH (more alkaline colonic environment) could result in more ammonia entering the circulation. While both low albumin and sodium levels are found in clients with liver failure, these are not associated with worsening hepatic encephalopathy.
A client suspects they may have developed an allergic response to latex. What most common allergic response would the nurse expect to find?
Contact dermatitis
A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?
Corticosteroids and immunosuppressant drugs Explanation: This woman's hepatitis is probably caused by an autoimmune disorder rather than a virus. Lamivudine, peginterferon/ribavirin, and interferon alfa-2b are all antiviral agents.
The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which manifestations does the nurse associate with TB? Select all that apply.
Cough, fever, night sweats
_____ disease is a recurrent, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract
Crohn
The term inflammatory bowel disease is used to designated two related inflammatory intestinal disorders: _____ disease and _____.
Crohn, ulcerative colitis
Which of the types of T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?
Cytotoxic T cells Explanation: Cytotoxic T cells destroy the pathogens. Regulatory T cells suppress immune response. Memory T cells are derived from normal T cells. The principal cells of the adaptive immune system are the T and B lymphocytes and antigen-presenting cells. T lymphocytes differentiate into helper T and regulatory T cells and cytotoxic T cells and provide cell-mediated immunity. CD4+ helper T cells serve as a trigger for the immune response and are essential for the differentiation of B cells into antibody-producing plasma cells and the differentiation of T lymphocytes into CD8+ cytotoxic T cells.
A nurse is concerned about a patient's continual use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which of the following is the nurse concerned about?
Damage to the gastric mucosa
A nurse who works in a long-term care facility has observed the high incidence of infectious illnesses among the older adults who reside there. What is the best explanation for a diminished immune capacity in older adults?
Decreased numbers and responsiveness of T lymphocytes.
A patient experiences an increase in thyroid hormone as a result of a thyroid tumor. Which of the following hormonal responses demonstrates the negative feedback mechanism?
Decreased thyroid-stimulating hormone (TSH) Explanation: Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, TSH, which is manufactured by the anterior pituitary gland, would normally stimulate release of thyroid hormones, but with the increase of those hormones by the secreting tumor, enough thyroid hormones flood the system that there should be a reduction in TSH levels.
_____ cells are specialized, bone marrow-derived leukocytes found in lymphoid tissue that are important intermediates between the innate and adaptive immune systems.
Dendritic
A client tells the doctor that every time he eats something made with wheat, barley, and/or rye, he gets sick. The doctors suspects the client has celiac sprue. The physician should further assess the client for: Select all that apply.
Diarrhea Abdominal pain Iron deficiency
Define dysphagia
Difficulty in swallowing
Which responses of the adaptive immune system provides protection against virus-infected cells?
Distinct antigenic properties allow T cells to isolate specific organisms.
Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites?
Diuretics. Because of the many limitations to sodium restriction, the use of diuretics has become the mainstay for treatment for ascites. A paracentesis may be done if diuretics do not correct the problem. A thoracentesis would never be done for ascites. DDAVP is given to decrease urine output, not to increase it.
A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain discriptors can be associated with adenocarcinomas of the pancreas?
Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward. Explanation: The most common pain [with pancreatic cancer] is a dull epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward. Sharp, stabbing pain with respirations could be pleurisy among other respiratory problems. Abdominal pain following a meal is usually assoicated with GERD or gastric ulcers. Cerebral edema causing headaches is not related to pancreatic cancer.
____ can result from disorders that produce narrowing of the esophagus, lack of salivary secretion, weakness of the muscular structures that propel the food bolus, or neural networks coordinating the swallowing mechanism
Dysphagia
What is measured in the serum to assess liver dysfunction?
Elevated serum enzyme tests usually indicate liver injury earlier than other indicators of liver function. The key enzymes are alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which are present in liver cells. Alanine aminotransferase is liver specific, whereas aspartate aminotransferase is derived from organs other than the liver. In most cases of liver damage, there are parallel rises in alanine aminotransferase and aspartate aminotransferase. The most dramatic rise is seen in cases of acute hepatocellular injury.
The mucous membrane linings of the gastrointestinal, respiratory, and urogenital tracts are protected by sheets of tightly packed ____ cells that block the entry of microbes.
Endothelial
Select the statement that best describes the effectiveness of vaccination in the elderly population.
Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults.
Malignant neoplasms tend to grow slowly. -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.
False -Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation.
The laboratory finds IgA in a sample of cord blood from a newborn infant. This finding is important because it signifies what?
Fetal reaction to exposure to an intrauterine infection. Cord blood does not normally contain IgM or IgA. If present, these antibodies are of fetal origin and represent exposure to intrauterine infection.
Crohn's disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes which of the following?
Fistula formation.
Philadelphia chromosome
Found in more than 90% of persons with CML
The most frequent symptom of _____ is heartburn.
GERD
What is GERD? What is the mechanism of damage?
GERD is Gastroesophageal reflux disease. It is thought to be associated with a weak or incompetent lower esophageal sphincter that allows reflux to occur, the irritant effects of the refluxate, and decreased clearance of the refluxed acid from the esophagus after it has occurred. In most cases, reflux occurs during transient relaxation of the esophagus. Gastric distention and meals high in fat increase the frequency of relaxation. Delayed gastric emptying also may contribute to reflux by increasing gastric volume and pressure with greater chance for reflux. Esophageal mucosal injury is related to the destructive nature of the refluxate and the amount of time it is in contact with mucosa. Acidic gastric fluids (pH < 4.0) are particularly damaging.
the most common cause of hyperthyroidism is this, which is accompanied b ophthalmopathy (or dermopathy) and diffuse goiter
Graves disease
Which of the following serves as recognition markers to aid in self-tolerance?
HLA antigens encoded by MHC genes
The most common forms of peptic ulcer are duodenal and gastric ulcers. Which of the following are the most common risk factors for peptic ulcer disease?
Helicobacter pylori (H. pylori)
_____ refers to inflammation of the liver.
Hepatitis
A baby is born to a mother with active hepatitis B. Which of the following medications does the nurse anticipate administering today?
Hepatitis B immune globulin (HBIG). Explanation: HBIG is used as an adjunct to hepatitis B vaccine for post-exposure immunoprophylaxis to prevent HBV infections in high risk populations. Tenofovir disoproxil fumarate plus emtricitabine is for HIV pre-exposure coverage. There is no hepatitis C vaccine available on the market yet. HAV is for hepatitis A vaccine which is usually spread from fecal-oral route rather than blood and body fluids.
The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify:
High serum amylase and lipase Explanation: Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin level may indicate liver disease. Chymotrypsin digests proteins in the intestine.
Define hormones
Highly specialized organic molecules produced by endocrine organs that exert their action on specific target cells
_____ is the major physiologic mediator for hydrochloric acid secretion.
Histamine
Define paracrine
Hormone acts on cell that produced it
Define autocrine
Hormone affecting neighboring cells
Select the statement that best explains the function of hormone receptors.
Hormone receptors recognize a specific hormone and translate the signal into a cellular response. Explanation: Hormone receptors are complex molecular structures that are located either on the surface of or inside target cells. The function of these receptors is to recognize a specific hormone and translate the hormonal signal into a cellular response. The other choices are not true.
What is a hormone?
Hormones generally are thought of as chemical messengers that are transported in body fluids. They are highly specialized organic molecules produced by endocrine organs that exert their action on specific target cells. Hormones do not initiate reactions but function as modulators of cellular and systemic responses. Most hormones are present in body fluids at all times, but in greater or lesser amounts depending on the needs of the body.
_____ immunity depends on maturation of B lymphocytes into plasma cells, which produce and secrete antibodies.
Humoral
_____ immunity, generated by B lymphocytes, is mediated by molecules called antibodies and is the principal defense against extracellular microbes and toxins.
Humoral
An essential property of the immune system is self-regulation. An immune response that is not adequate can lead to immunodeficiency, while an immune response that is excessive can lead to conditions from allergic responses all the way to autoimmune diseases. Which of these is not an example of a breakdown of the self-regulation of the immune system?
Huntington disease. Self-regulation is an essential property of the immune system. An inadequate immune response may lead to immunodeficiency, but an inappropriate or excessive response may lead to conditions varying from allergic reactions to autoimmune diseases. All answers are autoimmune diseases except for Huntington disease.
A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which of the following?
Hydration
_____ disorders refer to excessive or inappropriate activation of the immune system.
Hypersensitivity
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland?
Hypothalamus Explanation: The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, ?-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.
The physician is assessing a client with a preliminary diagnosis of endocrine disorder. Further assessment findings identify abnormalities with emotion, pain, body temperature, and neural input. The physician determines the need to further assess the:
Hypothalamus Explanation: The hypothalamus is the coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function. It is at the level of the hypothalamus that emotion, pain, body temperature, and other neural input are communicated to the endocrine system. The anterior pituitary regulates several physiological processes, including stress, growth, reproduction, and lactation. The cerebellum is involved in motor control, and the cerebral cortex is associated with sensory, motor, and association.
Which of the following immunoglobulins (Ig) is released in response to allergy or parasitic infections?
IgE
Type I hypersensitivity reaction
IgE mediated disorders
During the first few months of life, infants are protected from infection by IgG antibodies that originate in _____ circulation during fetal life.
IgG
Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta?
IgG
The nurse is aware that the only class of immunoglobulins to cross the placenta is:
IgG
Which of the following immunoglobulins (Ig) is the most abundant of circulating antibodies?
IgG
The nurse is reviewing the functions of immunoglobulins and determines which of the following as a correct action?
IgM/first to challenge the antigen Explanation: The correct actions are as follows: IgM is the first circulating immunoglobulin to appear in response to an antigen. IgA prevents the attachment of viruses and bacteria to epithelial cells. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. IgD serves as an antigen receptor for initiating the differentiation of B cells.
___________________________ an be defined as an abnormality in the immune system that renders a person susceptible to diseases normally prevented by an intact immune system.
Immunodeficiency
Antibodies comprise a class of proteins called _____.
Immunoglobulins
The health care provider has completed the assessment on a client with jaundice. The provider determines that which pathophysiologic abnormality could cause the jaundice?
Impaired uptake of bilirubin by the liver Explanation: The five major causes of jaundice are excessive destruction of RBCs, impaired uptake of bilirubin by the liver cells, decreased conjugation of bilirubin, and obstruction of the bowel flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts and excessive extrahepatic production of bilirubin. Jaundice would not occur as a result of decreased oxygen. Jaundice in newborns is the result of the breakdown of fetal hemoglobin.
A nurse is caring for a child diagnosed with DiGeorge Syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?
Increased risk of infection
Select the physiologic response that increases an obese woman's risk for the development of breast cancer.
Increased sex hormone production
The nursing student studying about cancer growth correctly identifies "cell proliferation" to mean which of the following?
Increasing cell numbers by mitotic cell division
The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On which of the following does the nurse base the knowledge of passive immunity?
Infants are protected at birth from infection by maternal IgG.
Define Hepatitis D
Infection is linked to hepatitis B
________________ is a self-limiting lymphoproliferative disorder caused by the Epstein-Barr virus
Infectious mononucleosis
_____ commonly is associated with acute or chronic inflammation or intrinsic disease of the colon, such as ulcerative colitis or Crohn disease.
Inflammatory diarrhea
A 22 year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.40 F. The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are sufficiently distressing that he/she is visiting a local medical clinic in the area. Which of the following diagnoses best characterizes this health problem?
Inflammatory diarrhea -Inflammatory diarrhea is often characterized by small-volume diarrhea that is bloody and accompanied by a fever. Noninflammatory diarrhea is normally larger in volume and not bloody. Factitious diarrhea is normally attributable to laxative use and secretory diarrhea is associated with increased secretory processes of the bowel; neither is likely to produce bloody stool.
Natural killer cells are specialized lymphocytes that are one of the major parts of which immunity?
Innate immunity. The major components of innate immunity are the skin and mucous membranes; phagocytic cells (mainly neutrophils and macrophages); specialized lymphocytes called natural killer cells; and several plasma proteins, including the proteins of the complement system. Adaptive, humoral, and cell-mediated immunity do not use natural killer cells
Define Hepatitis B
Inoculation with infected blood and/or spread by oral or sexual contact
Define second messenger
Intracellular signal
Philadelphia
It is generally believed that chronic myelogenous leukemia (CML) develops when a single, pluripotential, hematopoietic stem cell acquires _______ syndrome
Where in the gastrointestinal tract is food digested and absorbed?
It is in the jejunum and ileum that food is digested and absorbed.
Which of the following is the primary advantage of targeted cancer therapy? A: It has a shorter course of treatment than other therapies B: It is unlikely to cause nausea and vomiting C: It uses drugs that selectively attack only malignant cancer cells D: It can be administered on an outpatient basis
It uses drugs that selectively attack only malignant cancer cells
The nurse is caring for a client with severe acute pancreatitis. Which interventions should the nurse prioritize? Select all that apply.
Keep client NPO. Infuse intravenous fluids. Maintain nasogastric tube. Explanation: Treatment for severe acute pancreatitis includes withholding oral foods and fluids, and restoration of lost plasma volume with intravenous fluids. Meperidine rather than morphine usually is given for pain relief because it causes fewer spasms of the sphincter of the pancreatic duct. Gastric suction via nasogastric tube is used to treat bowel distention and prevent the secretion of pancreatic enzymes. Antidiarrheal medications are not indicated in acute pancreatitis.
When caring for the client with portal hypertension and ascites, which of these dietary interventions does the nurse suggest to prevent the progression of fluid accumulation?
Limit intake of sodium. Explanation: Treatment of ascites usually focuses on dietary restriction of sodium, administration of diuretics, and possible fluid restriction.
What laboratory markers are most commonly used to diagnosis acute pancreatitis?
Lipase and amylase. Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. Cholesterol and triglycerides are not used as laboratory markers for acute pancreatitis.
Which of the following cancers is the leading cause of cancer death?
Lung
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 -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.
A hospital client with a diagnosis of sepsis is in need of a specific response to microorganisms and a long-lasting immunity to the pathogens in question. Which component of the client's immune system is most able to meet these criteria?
Lymphocytes
Explain how a macrophage participates in antigen presentation.
Macrophages are key members of the mononuclear phagocytic system that engulf and digest microbes and other foreign substance. The monocytes migrate from the blood to various tissues where they mature into the major tissue phagocyte, the macrophages. As the general scavenger cells of the body, the macrophage can be fixed in a tissue or can be free to migrate from an organ to lymphoid tissues. The tissue macrophages are scattered in connective tissue or clustered in organs such as the lung (i.e. Alveolar macrophages), liver (i.e. Kupffer cells), spleen, lymph nodes, peritoneum, central nervous system (microglial cells), and other areas. Macrophages are activated to engulf and break down complex antigens into peptide fragments for association with class II MHC molecules. Macrophages can then present these complexes to the helper T cell so that self-nonself recognition activation of the immune response can occur.
Undefined or less differentiated cellular mass
Malignant mass
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. -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.
An obstetrics nurse is counselling an expectant mother. The mother is concerned about letting people hold her baby once it's born, fearing that the baby will get sick. What should the nurse explain to the mother?
Maternal immunoglobulins cross the placenta and protect the newborn early in life.
A client whose only diagnosis is essential hypertension is fasting for a fasting blood glucose and lipid profile test to be performed in the morning. The client's regular medications are currently on hold. What is the nurse's priority action?
Measure client's blood pressure and heart rate periodically. Explanation: This client is not at risk for hypoglycemia simply because of fasting. The negative feedback loop between blood glucose (BG) level and insulin levels will cause insulin levels to drop as the client's BG drops. Then, glucagon will be released and bind to surface receptors on liver cells to send a second intracellular message for glycogen breakdown, increasing BG and preventing hypoglycemia. The client is not taking the scheduled antihypertensives so the nurse should measure blood pressure and heart rate based on degree of risk for this client. Being off these medications means there is less risk for dizziness or orthostatic hypotension. When fasting, a client is permitted to consume water to prevent dehydration.
Describe the process and routes of metastasis
Metastasis occurs via lymph channels and blood vessels. 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. If they survive, cancer cells may spread from more distant lymph nodes to the thoracic duct, and then gain access to the blood vasculature. With hematologic spread, the blood borne cancer cells may enter the Venus flow that drains the site of the primary neoplasm. Cancer cells may also enter tumor-associated blood vessels that either infiltrate the tumor or are found at the periphery of the tumor.
Neurotransmitters like catecholamines (ex. dopamine and epinephrine) have a reaction time of:
Milliseconds. Explanation: The neurotransmitters, which control the opening of ion channels, have a reaction time of milliseconds.
Define Helicobacter pylori
Most common cause of chronic gastritis in the United States
____ are part of the innate immune system, and may be the first line of defense against viral infections. Natural killer cells
Natural killer cells
What is the most common mechanism of hormone control?
Negative feedback Explanation: With negative feedback, the most common mechanism of hormone control, some feature of hormone action directly or indirectly inhibits further hormone secretion so that the hormone level returns to an ideal level or set point.
The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body?
Negative feedback loop Explanation: The level of many of the hormones in the body is regulated by negative feedback mechanisms. The other answers are incorrect.
The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body?
Negative feedback loop. The level of many of the hormones in the body is regulated by negative feedback mechanisms.
The nurse is caring for a client with advanced cirrhosis who had a transjugular intrahepatic portosystemic shunt (TIPS) performed 3 months ago. Which assessments related to the client having a TIPS should the nurse prioritize? Select all that apply.
Neurologic assessment Platelet level Hemoglobin level Explanation: The TIPS procedure involves insertion of an expandable metal stent between a branch of the hepatic vein and the portal vein using a catheter inserted through the internal jugular vein. Stenosis and thrombosis of the stent can occur, which would lead to an increase in portal hypertension. Because this could lead to esophageal bleeding, the hemoglobin level should be monitored. Splenomegaly and the resulting thrombocytopenia associated with portal hypertension means platelets should also be monitored. Another complication of TIPS is hepatic encephalopathy, so the nurse should include a neurologic assessment. The TIPS will not directly affect albumin levels or peripheral edema.
A blood smear is being examined and a stain has been added that will identify granulocytes. Which cell types will be visible with the stain? Select all that apply.
Neutrophil, eosinophil, basophil
____ are the early responding cells of innate immunity.
Neutrophils
Neutrophils are very important as a first line of defense against viral/bacterial infection. Explain what a neutrophil does and the condition that results from a deficiency of neutrophils.
Neutrophils engulf, digest, & destroy microorganisms at the site of infection. Neutrophil deficiency would cause a person to be more prone to infections.
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 -Normal cells have regulated growth, high differentiation, genetic stability, growth factor dependence, high density dependence, and cell-to-cell adhesion.
Protooncogene
Normal gene that can cause cancer if mutated
_____ deficiencies are common in Crohn disease because of diarrhea, steatorrhea, and other malabsorption problems.
Nutritional
A child has a congenital condition in which the thymus gland is absent. What should the nurse include in the education of care of this patient to the parents?
Observe and report signs and symptoms of infection. Explanation: The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes.
Define Hepatitis A
Occurs primarily by the fecal-oral route
A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what?
Opportunistic infection
____ is the coating of a microorganism with soluble molecules that tag the microorganisms for more efficient recognition by phagocytes.
Opsonization
The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:
Opsonization. Opsonization is the coating of particles with proteins, lectins, and complement to make them more attractive for phagocytes to recognize them as a foreign pathogen
When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which of these descriptions?
Pain in the right upper quadrant referred to the same shoulder Explanation: The pain of biliary colic begins abruptly and increases in intensity. It is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students' recognize the local action of hormones as:
Paracrine Explanation: When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones also can exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.
What is paraneoplastic syndrome?
Paraneoplastic syndromes are characterized by manifestations in sites that are not directly affected by the disease. Most commonly, manifestations are caused by the elaboration of hormones by cancer cells, and others from the production of circulation factors that produce hemoatopoietic, neurologic, and dermatological syndromes.
A patient is not able to absorb vitamin B12. The nurse determines that the patient is deficient in:
Parietal (oxyntic) cells, which secrete HCl and intrinsic factor
A woman experiences a viral infection while pregnant. Which of the following types of immunity does an infant have at birth against this infection?
Passive Explanation: Active immunity is acquired through exposure to antigens and having the B and T lymphocytes develop a response. Passive immunity is when the antibodies against an antigen are transferred directly to the host, such as when a fetus gains from the mother's immune system. Tolerance is the ability of the immune system to react to foreign substances but not the body cells. Adaptive immunity is when the immune system responds to antigens and is moderated by B and T lymphocytes.
_____ is a term used to describe a group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions.
Peptic ulcer
Which gland is often referred to as the master gland because it secretes many hormones?
Pituitary Explanation: The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. That is not a term used to refer to the other options.
_____ is characterized by increased resistance to flow in the portal venous system and sustained portal vein pressure above 12 mmHg.
Portal hypertension
The nurse is planning care for a client with a diagnosis of primary immunodeficiency. Which of the following is a priority intervention to incorporate into the plan?
Protecting the client from infection Explanation: The client with immunodeficiency has an absent or inadequate immune response. Cell-mediated, or cellular, immunity is mediated by the cytotoxic T lymphocytes (T cells) and functions in the elimination of intracellular pathogens. A lack of this response increases the client's risk of infection.
A patient has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and:
Proton Pump inhibitors -H. pylori is associated with an increased risk of gastric adenocarcinoma, gastric atrophy and peptic ulcer. It is less likely to contribute to IBD, esophagitis or diverticular disease. Eradication of H. pylori is difficult. Treatment required a combination therapy that includes the use of antibiotics and a proton pump inhibitor. The proton pump inhibitors have direct antimicrobial properties against H. pylori. Anti-anxiety medications will not kill the bacteria. H. pylori is not associated with elevated blood ammonia levels. Calcium carbonate is usually given to relieve heartburn caused by GERD.
After several months of persistent heartburn, a 57 year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?
Proton pump inhibitors; avoiding large meals; remaining upright after meals -Proton pump inhibitors block the final stage of gastric acid production, effectively controlling the root cause of the esophageal damage associated with GERD. The pylorus is not involved and a soft diet is not indicated. Calcium channel blocking drugs would not address the problem. Calcium channel blockers are primarily heart disease drugs that relax blood vessels and increase the supply of blood and oxygen to the heart while also reducing the heart's workload.
The types of genes involved in cancer are numerous, with two main categories being the ______, which control cell growth and replication, and tumor _____ genes, which are growth-inhibiting regulatory genes
Protooncogenes, suppressor
A 55-year-old man has been diagnosed with a gastroesophageal reflux disease (GERD), in which the function of his lower esophageal sphincter is compromised. Which of the following consequences of this condition is most likely to occur? A) Decreased absorption of ingested foods and fluids B) Impaired control of the gastric emptying rate C) Protrusion of the stomach or regurgitation of stomach contents into the esophagus D) Inappropriate release of gastric enzymes
Protrusion of the stomach or regurgitation of stomach contents into the esophagus
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. • Post surgically, chemotherapy and radiation tratments have been ordered for Mrs. B. • What are two educational points to discuss with Mrs. B. about radiation therapy?
Radiation treatments kill rapidly dividing cells through DNA damage or production of free radicals. Only a certain number of cells are killed with each treatment, so you will require several treatments in order to kill the most cancer cells. For breast cancer you will receive special marking on your skin to identify where the radiation will be given. This ensures that the radiation beam is pointed directly at the tumor for best results.
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
Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?
Rapidly proliferating cells
_____ T cells suppress immune responses by inhibiting the proliferation of other potentially harmful self-reactive lymphocytes.
Regulatory
The results of recent research suggests that a key role in the origin of some diseases is played by inflammation. Which of these diseases is it thought that inflammation has a role in its beginnings?
Rheumatoid arthritis. Among the functions of the innate immune system is induction of a complex cascade of events known as the inflammatory response. Recent evidence suggests that inflammation plays a key role in pathogenesis of a number of disorders such as atherosclerosis and coronary artery disease, bronchial asthma, type 2 diabetes mellitus, rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus. Osteoporosis is the abnormal loss of bone tissue and density. Osteogenesis imperfect is a genetic disease causing multiple bone fractures in a newborn. Hydronephrosis is a condition of the kidney causing distention of the pelvis and calyces because of an obstruction in the ureter causing an inability of urine to pass.
The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest:
Right upper quadrant pain Explanation: The pain is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, right shoulder, or midscapular region. Typically, the pain is abrupt in onset, increases steadily in intensity, persists for 2 to 8 hours, and is followed by soreness in the upper right quadrant.
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
A client is being evaluated for atopic dermatitis possibly caused by a latex-related allergic reaction. The nurse will review which of the following labs to determine if an allergy is present?
Serum IgE Explanation: IgE binds to mast cells and basophils and is involved in parasitic infections, allergic and hypersensitivity reactions. Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders
The first physical line of defense in innate immunity is:
Skin and mucous membranes Explanation: The first physical line of defense are the skin and mucous membranes, which prevent pathogens from entering. Plasma proteins, neutrophils, and specialized lymphocytes are examples of cellular level protection.
A patient is admitted to the hospital for further evaluation of problems experienced with gastrointestinal digestion and absorption. The nurse anticipates the health care provider will further assess the:
Small intestine
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. You are going to give a community presentation on the risk factors for cancer. What would include in your teaching plan?
Smoking tobacco (and maybe vaping), alcohol intake, specific considerations about red or preserved meats and cooking meats. Other risks include radiation exposure, obesity, immunosuppression (HIV, elderly or taking steroid medications), chronic inflammatory processes from viral infection or inflammatory bowel disease, family history (breast, colon, retinoblastoma) How would you describe inherited gene mutation? Think about the concept of loss of heterozygosity and epigenetics.
The cause of gastric carcinomas has been influenced by which of the following factors? Select all that apply.
Strain of Helicobacter pylori (H. pylori), Environmental factors, and Family history.
Collectively, _____ protect against fungal, protozoan, viral, and intracellular bacterial infections; control malignant cell proliferation; and are responsible for coordinating the overall immune response.
T lymphocytes
There are many cells that make up the passive and adaptive immune systems. Which cells are responsible for the specificity and memory of adaptive immunity?
T lymphocytes and B lymphocytes. The T and B lymphocytes are the only cells in the body capable of specifically recognizing different antigenic determinants of microbial agents and other pathogens, and therefore responsible for two defining characteristics of adaptive immunity, specificity and memory. Phagocytes, dendritic cells, and natural killer cells all participate in innate immunity.
Which of the following explains how T lymphocytes and B lymphocytes differ?
T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow.
The nurse knows the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are:
T-and B-lymphocytes. Explanation: T- and B- lymphocytes are unique in that they are the only cells in the body capable of recognizing specific antigens present on the surfaces of microbial agents and other pathogens.
Type IV hypersensitivity reaction
T-cell mediated disorders
A client with osteoarthritis arrives in the emergency department with complaints of sudden onset weakness, dizziness, and diarrhea that the client says is dark. The nurse notes a low blood pressure with tachycardia. Which laboratory test should the nurse prioritize to be completed first?
The client is presenting with the signs of acute blood loss from the gastrointestinal tract. The fact that the client has osteoarthritis is a strong indicator for NSAID use, which adds to the risk profile. Only measuring the hemoglobin level is directly related to determining the severity of blood loss and helping to direct treatment. A fecal occult blood test is indicated for occult losses, not obvious blood loss, nor can it help determine the severity of blood loss in the manner that the hemoglobin level can. While electrolytes and liver function tests may also be conducted, they are not the priority compared to the current hemoglobin level.
Describe the clinical course of viral hepatitis.
The clinical course of viral hepatitis involves a number of syndromes, including asymptomatic infection with only serologic evidence of disease, acute hepatitis, the carrier state without clinically apparent disease or with chronic hepatitis, chronic hepatitis with or without progression to cirrhosis, with rapid onset of liver failure. Not all hepatotoxic viruses provoke each of the clinical syndromes.
Cancers are graded and staged on their characteristics in order to determine a treatment regimen. Explain the grading and staging system and how it is met.
The clinical staging of cancer is intended to group patients according to the extent of their disease. Grading of tumors involves the microscopic examination of cancer cells to determine their level of differentiation and the number of mitoses. Cancers are classified as grades I, II, III, IV with increasing anaplasia or lack of differentiation. The two basic methods for classifying cancers are grading according to the histologic or cellular characteristics of the tumor and staging according to the clinical spread of the disease.
A client who is referred to the endocrinologist's office for an evaluation of his hormone levels asks what regulates the hormone levels. The best response would be that hormone levels in the body are primarily regulated by:
The hypothalamic-pituitary-target cell system Explanation: The levels of many of the hormones are regulated by feedback mechanisms that involve the hypothalamic-pituitary-target cell system. Positive feedback control refers to rising levels of a hormone that causes another gland to release a hormone that is stimulating to the first. The hypophyseal portal system connects the supraoptic and paraventricular nuclei of the hypothalamus with the posterior pituitary gland. Exogenous forms of hormones (given as drug preparations) can influence the normal feedback control of hormone production and release.
How many classes of antibody are there? Give a brief definition of unction for each one.
The immunoglobulins have been divided into five classes: IgG, IgA, IgM, IgD, and IgE. 1. IgG protects against bacteria, toxins, and viruses in body fluids and activates the complement system. 2. IgA is a primary defense against local infections in mucosal tissues. 3. IgM is the first circulating immunoglobulin to appear in response to an antigen. 4. IgD serves as an antigen receptor for initiating the differentiation of B cells. 5. IgE is involved in inflammation, allergic responses, and combating parasitic infections.
What is the innate immune system and what is its function?
The innate immune system consists of epithelial barriers, phagocytic cells (mainly neutrophils and macrophages), natural killer (NK) cells, and several plasma proteins including those of the complement system. These mechanisms are present in the body before an encounter with an infectious agent and are rapidly activated by microbes before the development of adaptive immunity. The activation and regulation of inflammation is also a major job of innate immunity.
How does negative feedback regulate hormone levels?
The level of hormones in the body is regulated by negative feedback mechanisms. Sensors detect a change in the hormone level and adjust hormone secretion so that body levels are maintained within an appropriate range. When the sensors detect a decrease in hormone levels, they initiate changes that cause an increase in hormone production; when hormone levels rise above the set point of the system, the sensors cause hormone production and release to decrease the level.
What are the basic functions of the liver?
The liver is one of the most versatile and active organs in the body. It produces bile; metabolizes hormones and drugs; synthesizes proteins, glucose, and clotting factors; stores vitamins and minerals; changes ammonia produced by deamination of amino acids to urea; and converts fatty acids to ketones. The liver degrades excess nutrients and converts them into substances essential to the body. In its capacity for metabolizing drugs and hormones, the liver serves as an excretory organ.
A 51 year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function?
The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. Explanation: Protein, carbohydrate and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer's cells. Absorption of nutrients takes place in the intestines and the liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid-base or electrolyte balance.
Define Hepatitis C
The most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world.
What is the pathophysiologic of constipation?
The pathophysiology of constipation can be classified into three broad categories: normal-transit constipation, slow-transit constipation, and disorders of defecator or rectal evacuation. Normal-transit constipation (or functional constipation) is characterized by perceived difficulty in defecation and usually responds to increased fluid and fiber intake. Slow-transit constipation, which is characterized by infrequent bowel movements, is often caused by alterations in intestinal innervation. Hirschsprung disease is an extreme form of slow-transit constipation in which the ganglion cells in the distal bowel are absent because of a defect that occurred during embryonic development; the bowel narrows at the area that lack ganglionic cells. Although most persons with this disorder present in infancy or early childhood, some with a relatively short segment of involved colon do not have symptoms until later in life. Defecatory disorders are most commonly due to dysfunction of the pelvic floor or anal sphincter.
In an attempt to best explain the innate immune system to a class of first-year nursing students, the instructor should describe what characteristic?
The response of the innate immune system is rapid, usually within minutes to hours, and prevents the establishment of infection and deeper tissue penetration of microorganisms.
Describe the functional divisions of the GI tract.
The upper part - the mouth, esophagus, and the stomach - act as an intake source and receptacle through which food passes and in which initial digestive processes take place. The middle portion - the duodenum, jejunum, and ileum - the place where most digestive and absorptive processes occur. The lower segment - the cecum, colon, and rectum, serves as a storage channel for the efficient elimination of waste.
What is the general function of neutrophils and macrophages in the inflammatory response?
These phagocytic cells recruited during an inflammatory response to recognize and kill infectious invaders. The early-responding innate immune cell is the neutrophil, followed shortly by the more efficient, multifunctional macrophage. They are activated to engulf and digest microbes that attach to their cell membrane. Once the cell is activated and the microbe is ingested, the cell generates digestive enzymes, toxic oxygen, and nitrogen intermediates (i.e. hydrogen peroxide or nitric oxide) through metabolic pathways. The phagocytic killing of microorganisms helps to contain infectious agents.
The nurse is explaining to a colleague the basis of a client's allergy to dust. What statement by the nurse most accurately describes antigens in this situation?
They are substances foreign to the host that can stimulate an immune response.
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. What questions would you ask about family history?
Think about the possibility of having inherited the BRCA1 or BRCA 2 gene mutation for cancer. Quesitons may include: "Has anyone in your family had breast, ovarian or prostate cancer?" "What age was your family member when diagnosed with cancer? There is a higher risk of cancer for those whose family members were diagnosed with breast cancer before the age of 50. "Have you or anyone in your family had genetic testing for breast cancer? Depending on how Mrs. B answers, she may be candidate for genetic testing for the BRCA1 & 2 mutations.
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. - How will the nurse respond to Mrs. B?
This is a difficult question for all practitioners! Start by telling Mrs. B that we don't have enough information to know if she has cancer at this time. Explain that the healthcare provider will be doing an exam and then ordering a mammogram and possibly other tests to find out if the lump is cancerous. After that, the healthcare provider will discuss prognosis and treatment if needed.
Stem cells in the bone marrow produce T lymphocytes or T cells, and release them into the vascular system. The T cells then migrate where to mature?
Thymus. The T lymphocytes (T cells) are generated from stem cells in the bone marrow and complete their maturation in the thymus and functions in the peripheral tissues to produce cell-mediated immunity, as well as aiding antibody production.
The nurse administers a glucocorticoid medication to a client with pneumonia. Which of these does the nurse teach the client is the purpose of the medication?
To decrease airway inflammation Explanation: Glucocorticoids affect metabolism of all nutrients and have anti-inflammatory effects, which can assist with airway inflammation.
One of the self-regulatory actions of the immune system is to identify self-antigens and be nonreactive to them. What is this ability of the immune system defined as?
Tolerance. The term tolerance is used to define the ability of the immune system to be nonreactive to self-antigens while producing immunity to foreign agents. All other responses have nothing to do with the recognition and tolerance of self-antigens
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. Mrs. B. is scheduled for a Right Mastectomy. In discussing future treatments with Joanie, what other cancer treatments may be ordered?
Treatment will be determined after consultation with an oncologist and focuses on cure, control or palliative treatment. Most commonly, radiation and chemotherapy will be ordered. In addition, testing of the cancer cells may determine if a specific course of treatment may be beneficial, such as avoidance of estrogen, or a medication that decreases receptor activity for estrogen. If Mrs, B were to test positive for the BRCA 1 or 2 mutation, she may also be offered the choice of havng her other breast or ovaries removed in order to decrease her future risk of cancer.
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
Define Fistulas
Tubelike pasages that form connections between different sites in the gastrointestinal tract.
A 60 year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers?
Tumor marker alone aren't enough to confirm whether you have cancer of not, so they're not a very useful screening tool
Promote cancer when less active
Tumor suppressor gene
Explain how a patient can become sensitized to an allergen (antigen) in a type I hypersensitivity reaction.
Type I hypersensitivity reactions begin with mast cell or basophil sensitization. During the sensitization or priming stage, allergen-specific IgE antibodies attach to receptors on the surface of mast cells and basophils. With subsequent exposure, the sensitizing allergen binds to the cell-associated IgE and triggers a series of events that ultimately lead to degranulation of the sensitized mast cells or basophils, causing release of their preformed mediators. Mast cells are also the source of lipid-derived membrane products (e.g. prostaglandins and leukotrienes) and cytokines that participate in the continue response to the allergen.
There are three different types of antibody-mediated mechanisms involved in ____ reactions: Opsonization and complement- and antibody receptor-mediated phagocytosis, complement- and antibody receptor-mediated inflammation, and antibody-mediated cellular dysfunction.
Type II
___ hypersensitivity reactions are responsible for the Vasculitis seen in certain autoimmune diseases, such as systemic lupus erythematosus (SLE), or the kidney damage seen with acute glomerulonephritis.
Type III
Hypersensitivity reactions that are mediated by specifically sensitized T lymphocytes are divided into two basic types: direct cell-mediated cytotoxicity and delayed-type hypersensitivity, and generally classified as ______.
Type IV
Which of the following is the most common mode of transmission of HIV?
Vaginal and anal intercourse
treatment of cancer by chemotherapeutic drugs
What is the attributing factor in the increased incidence of drug-induced neutropenia? - treatment of cancer by chemotherapeutic drugs - the decrease in the use of street drugs - the destruction of tissue cells by cocaine
When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?
Yellow-tinged sclera Explanation: The icterus phase is reflected by development of jaundice of skin and sclera, liver tenderness and worsened prodromal symptoms.
Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. The biopsy results were positive for cancer. Why would a sentinel node biopsy be advisable for Mrs. B?
Yes. In order to test for metastasis, a sentinel node bipsy will be performed. Remember that cancer can spread via the lymph system or via blood with lymphatic spread being the most common. As cancer cells leave their site of origin, they appear in the first lymph node that drains the organ of cancer origin, which indicates that the cancer has started to spread. Depending on the results, further testing may include looking for other tumors, such as in the other breast, lung or liver.
chronic leukemias
_________ are malignancies involving proliferation of more fully differentiated myeloid and lymphoid cells
acute leukemias
_____________ usually have a sudden and stormy onset with S/S related to depressed bone marrow function
A 48 year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which of the following facts most accurately conveys an aspect of his diagnosis?
a) He is likely to have lesions on his skin, mouth or GI tract. The lesions of KS can be found on the skin and in the oral cavity, gastrointestinal tract, and the lungs. More than 50% of people with skin lesions also have gastrointestinal lesions. It is linked with a herpes virus and can often be painless, especially in early stages. Men who have sex with men are at a higher risk of developing KS
Good hand-washing techniques are important in healthcare. The nurse knows that bacterial infections can be prevented by good hand-washing techniques. Which of the following routes of transmission is most common for Clostridium difficile?
a) Vertical transmission b) Iatrogenic transmission c) Sexual transmission d) Fecal-oral transmission Fecal-oral transmission After antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route. C. difficile infection usually is acquired in the hospital, where the organism is most commonly encountered.
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 patient needs further teaching when he makes which remark? a. This tumor I have, will I die from it? b. Even though benign tumors can't stop growing, they aren't considered cancer. c. Benign tumors still produce normal cells different from other cells around them. d. This kind of tumor can't invade other organs or travel to other places in the body to start new tumors.
a. This tumor I have, will I die from it? 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.
The liver, the gallbladder, and the exocrine pancreas are classified as ___ organs of the gastrointestinal tract
accessory
The ____ immune response is composed mainly of T and B cells and responds to infections more slowly, but more specifically, than the innate immune system.
adaptive
The most important of the secretory proteins of the liver is _____.
albumin
Although the immune response normally is protective, it also can produce undesirable effects such as when the response is excessive, as in ______, or when it recognizes self-tissue as foreign, as in ____ disease.
allergies, autoimmune
neutropeniaa
an abnormally low number of neutrophils
Loss of cell differentiation
anaplasia
The term ____ is used to describe the loss of cell differentiation in cancerous tissue.
anaplasia
_____ is a common side effect of many cancers. It is related to blood loss, hemolysis, impaired red cell production, or treatment effects.
anemia
A common manifestation of solid tumors is the cancer ___ syndrome.
anorexia-cachexia
Type II hypersensitivity reaction
antibody-mediated disorders
Substances that elicit adaptive immune responses are called ______.
antigens
Process that removes senescent and or damaged cells
apoptosis
There is considerable evidence linking gastroesophageal reflux with _____.
asthma
Persons with ____ allergic conditions tend to have high serum levels of IgE and increased numbers of basophils and mast cells.
atopic
Hormones also can exert an ___ action on the cells from which they were produced
autocrine
____ diseases represent a group of disorders that are caused by a breakdown in the ability of the immune system to differentiate between self- and non-self-antigens.
autoimmune
Which one of the following is the main effect of HIV infection?
b) Poor helper T-cell function HIV infects a limited number of cell types in the body, including a subset of lymphocytes called CD4+T lymphocytes (also known as T-helper cells or CD4+T cells). The CD4+T cells are necessary for normal immune function. Among other functions, the CD4+T cell recognizes foreign antigens and helps activate antibody-producing B lymphocytes. The phagocytic function of monocytes and macrophages is also influenced by CD4+T cells.
A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which of the following statements is appropriate direction from the student's nursing instructor?
b) Wear gloves if there is a chance you will come in contact with the client's blood or body fluids. Universal Blood and Body Fluid Precautions should be used in encounters with all people in the health care setting. Occupational risk of infection for health care workers most often is associated with percutaneous inoculation of blood from a person with HIV infection. HIV infection is not transmitted through casual contact. (less)
A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be: a) difficulty swallowing b) fistula formation c) excessive weight gain d) chronic constipation
b) fistula formation -Complications of crohn disease: include fistula formation, abdominal abscess formation, and intestinal obstruction
The nurse in an oncology unit has jut admitted a patient with metastatic cancer. The patient asks how cancer moves from one place to another in the body. What would the nurse answer? a. The cancer cells are not able to float around the original tumor in body fluids. b. Cancer cells enter the body's lymph system and thereby spread to other parts of the body. c. Cancer cells are moved from one place in the body to another by transporter cells. d. Cancer cells replicate and form a chain that spreads from the original tumor site to there site of the metastatic lesion.
b. Cancer cells enter the body's lymph system and thereby spread to other parts of the body. Via blood or lymph; can shed into fluid surrounding tumor
Cancer cells differ from normal cells in many ways. They have lost their ability to accurately communicate with other cells, and they do not have to be anchored to other cells to survive. How else are they different from other cells? (select all that apply). a. cancer cells have an increased tendency to stick together. b. cancer cells have an unlimited life span. c. cancer cells need decreased amounts of growth factor to proliferate d. cancer cells need increased amounts of growth factor to proliferate e. cancer cells are termed genetically unstable
b. cancer cells have an unlimited life span. c. cancer cells need increased amounts of growth factor to proliferate e. cancer cells are termed genetically unstable 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 Ability to proliferate even in the absence of growth factors Genetic instability
Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues? a. transformation b. neoplasm c. mutation d. insertion
b. neoplasm An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm Transformation occurs when a cell has become cancerous Mutation is an alteration in the DNA that may or may not result in a transformation Insertion is a type of mutation
The nurse is caring for a group of clients. Which client should the nurse prioritize as being most at risk for developing hypoglycemia? The client:
being treated for type 1 diabetes who has been having nausea and vomiting for 4 hours Explanation: Only excess of insulin for the current amount of available blood glucose can result in hypoglycemia; the healthy pancreas will not produce excess insulin. Therefore, the only client at risk for hypoglycemia is the person being treated for type 1 diabetes, as this would mean the client is receiving exogenous insulin. Even if only ill for 4 hours, this exogenous insulin in the absence of enough glucose could cause hypoglycemia. The client with type 2 diabetes has not taken any medication, so despite not eating his or her blood glucose will only rise due to the pancreas reducing an endogenous insulin production as blood glucose falls; the activation of counter-regulatory hormones will also prevent hypoglycemia. This normal negative feedback system will also prevent hypoglycemia in the other clients who are not having oral intake.
Well-differentiated mass of cells
benign mass
A major exocrine function of the liver is _____ secretion.
bile
A tissue _____ involves the removal of a tissue specimen for microscopic study.
biopsy
The central lymphoid organs, the ____ and the _____, provide the environment for immune cell production and maturation.
bone marrow, thymus
A patient is being treated for an anaphylactic reaction after eating shrimp. Which of the following classes of antibodies mediates the anaphylaxis?
c) IgE Anaphylaxis is a catastrophic, systemic life-threatening IgE-mediated hypersensitivity reaction associated with the widespread release of histamine into the systemic circulation that produces massive vasodilation, hypotension, arterial hypoxia, and airway edema.
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? a. Body type, age, and hereditary. b. Radiation, cancer-causing viruses, and color of skin. c. Hormonal factors, chemicals, and immunologic mechanisms. d. Immunologic mechanisms, cancer-causing viruses, and color of skin.
c. Hormonal factors, chemicals, and immunologic mechanisms. Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunological mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been an 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.
______ is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites.
chemotherapy
B-lymphocytes
chronic lymphocytic leukemia, a clonal maligancy of _________, is the most common form of leukemia in adults in the Western world
Ulcerative colitis is confined to _____ and _____.
colon, rectum
leukemia
cytogenetic studies have shown that recurrent chromosomal changes occur in over half of all cases of ______
The usual definition of _____ is excessively frequent passage of stools.
diarrhea
Malignant neoplasms are less well ____ and have the ability to break loose, enter the circulatory or lymphatic systems, and form secondary malignant tumors at other sites.
differentiated
Process of cell specialization
differentiation
______ is the process of specialization whereby new cells acquire the structure & function of the cells they replace.
differentiation
Cancer is a disorder of altered cell ___ and ___
differentiation and growth
The patient tells the nurse that she is very anxious and that her pulse is racing. Which of the following will the nurse expect to see in the gastrointestinal (GI) tract?
dry mouth
The small intestine, which forms the middle portion of the digestive tract, consists of three subdivisions: the _____, _____, and _____.
duodenum, jejunum, ileum
Hepatic _____ refers to the totality of central nervous system manifestations of liver failure.
encephalopathy
Changes in gene expression without DNA mutation
epigenetic effects
The _____ cells carry out the secretory and absorptive functions of the GI tract and they produce the ____ that lubricates and protects the inner surface of the alimentary canal.
epithelial, mucus
The ___ functions primarily as a condult for the passage of food and liquid from the pharynx to the stomach
esophagus
Hormones that are released into the bloodstream circulate either as _____ molecules, or as hormones _______ to transport carriers.
free, bound
G cells secrete _____.
gastrin
The major physiologic function of the _____ is to digest food and absorb nutrients into the bloodstream.
gastrointestinal (GI) system
Marked by chromosomal aberrations
genetic instability
A characteristic of cancer cells is the ability to proliferate even in the absence of _____.
growth factors
The endocrine system uses chemical substances called ____ as a means of regulating and integrating body functions.
hormones
The adaptive immune system is further divided into the ___ and _____ immune systems.
humoral, cellular
The synthesis and release of anterior pituitary hormones is regulated by the action of releasing or inhibiting hormones from the ______, which is the coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function.
hypothalamus
Blast cells
immature precursor cells
Under normal conditions, the __ response deters or prevents disease.
immune
The ___ has evolved in multicellular organisms to defend against bacteria, viruses, and other foreign substances.
immune system
Currently, recreational _____ use is the most common mode of hepatitis C virus transmission in the United States and Canada. The main route of transmission of hepatitis C virus in the past was through contaminated _____ or blood products and ______.
injection drug, blood transfusions, high-risk sexual behavior
As the first line of defense, ____ immunity consists of the physical, chemical, molecular, and cellular defenses.
innate
The ___ immune system is composed of the phagocytic leukocytes , natural killer (NK) cells and complement proteins
innate
Which of the following is a characteristic indicator that an individual is in the latent phase of HIV?
lack of symptoms
_______ can involve lymphocytes, granulocytes and other blood cells
leukemias
the _____ are malignant neoplasms of cells originally derived from hematopoietic precursor cells
leukemias
Among the factors identified as etiologic agents in _____ are chronic viral hepatitis, cirrhosis, long-term exposure to environmental agents such as aflatoxin, and drinking water contaminated with arsenic.
liver cancer
_______ originate in peripheral lymphoid structures such as the lymph nodes where B and T lymphocytes undergo differentiation and proliferation
lymphomas
During an inflammation response, the monocyte leaves the blood vessel, transforms into a tissue _____, and phagocytosis bacteria, damaged cells, and tissue debris.
macrophage
Dendritic cells and ____ function as antigen-presenting cells for adaptive immunity.
macrophages
A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:
metabolizes most components of food and also cleans the blood of bacteria and drugs. Explanation: Protein, carbohydrate, and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer cells. Absorption of nutrients takes place in the intestines and the liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid--base or electrolyte balance.
Cancer prognosis has improved most dramatically when treatment plans include which of the following? A: aggressive chemotherapy B: multiple types of treatment C: surgical procedures D: pinpointed radiation
multiple types of therapy
the granulocyte and monocyte cell lines derive from the ______ stem cells and the lymphocytes from the ______ stem cells
myeloid, lymphoid
Another population of lymphocytes includes the __ cells, which do not share the specificity or characteristics of the T or B lymphocytes, but have the ability to lyse target cells.
natural killer
The term _____ refers to an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues.
neoplasm
Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues?
neoplasm
early signs of infection of ______ include mild skin lesions, stomatitis, pharyngitis, and diarrhea
neutropenia
The key cells of innate immunity are _____, _____, and natural killer cells
neutrophils, macrophages
Typical symptoms seen in the latent period of HIV infection include which of the following?
no signs or symptoms
Tumor suppressor gene
p53
With homologous loss of ____ gene activity, DNA damage goes unrepaired and mutations occur in dividing cells, leading to malignant transformations.
p53
When hormones act locally on cells other than those that produced the hormone, the action is called ______.
paracrine
The ____ cells secrete hydrochloric acid and intrinsic factor, which is necessary for the absorption of _____.
parietal, vitamin B12
The binding of ____ to the pattern recognition receptors on leukocytes initiates the signaling events that lead to innate immunity and tissue changes associated with acute inflammation.
pathogens
Process of cell division
proliferation
The process of cell division results in cellular ________.
proliferation
_____ therapy uses high-energy particles or waves to destroy or damage cancer cells.
radiation
The structure of hormone _____ varies in a manner that allows target cells to respond to one hormone and not to others.
receptors
Cushing syndrome
refers to the manifestations of hypercortisolism from any cause
Allergic ___ is characterized by symptoms of sneezing, itching, and watery discharge from the nose and eyes.
rhinitis
The ability of the immune system to differentiate self from nonself is called _____.
self-tolerance
There are two categories of malignant neoplasms, _____ and ____ cancers.
solid tumors, hematologic
The white pulp layer of the _____ contains concentrated areas of B and T lymphocytes permeated by macrophages and dendritic cells.
spleen
Which of the following is a secondary lymphoid structure located high in the left abdominal cavity?
spleen
lymphocytic
the _______ leukemias involve immature lymphocytes and their progenitors that originate in the bone marrow but infiltrate the spleen, lymph nodes, CNS, and other tissues
lymphocytic, monocytic
there are two types of acute leukemia: acute ____ and acute ______
T lymphocytes mature in the ___
thymus
the body's lymphatic system consists of the lymphatic vessels, lymphoid tissue and lymph nodes, ______ , and _______.
thymus, spleen
The nurse knows a drug in a category identified as a colony-stimulating factor (CSF) helps:
to stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes. Explanation: CSFs participate in hematopoiesis by stimulating bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of mature platelets, erythrocytes, lymphocytes, neutrophils, monocytes
Mass of cells due to overgrowth
tumor
Night sweats
what clinical feature do ALL and AML share? - night sweats - weight gain - high fever
rupture of the spleen
which of the following complications can arise during this mostly benign disease (infectious mononucleosis)? - peripheral nerve palsies - rupture of the spleen - rupture of the lymph nodes
The school nurse is preparing a lecture on HIV/AIDS for a health class of high school students. The nurse would know to include what information about the transmission of AIDS in her lecture? (Select all that apply.)
• AIDS is transmitted through sexual contact. • AIDS is transmitted through blood-to-blood contact. • AIDS is transmitted from the mother to her unborn baby.
A teenager has been exposed to a person infected with chicken pox. After two weeks, the client has not contracted the virus. How is this possible? Select all that apply.
• The client was previously exposed to chicken pox. • The client was vaccinated for chicken pox. Explanation: Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination or from environmental exposure. It is called active immunity because it requires the host's own immune system to develop an immunological response including the development of memory. Passive immunity transferred from mother to fetus only lasts a few weeks to months following birth.
A nurse is teaching a group of seniors about the decline of the immune system due to aging. Which of the following topics should be included in the teaching plan regarding the immune response of the elderly? Select all that apply.
• Weakened response to vaccinations • Increase in susceptibility to infections • Higher incidence of cancer Explanation: As we age, the ability of the immune system to protect the body from pathogenic organisms and environmental toxins declines as a result of an overall decline in immune responsiveness. This results from changes in both cell-mediated and humoral immune responses. As a result, older adults are more susceptible to infections, have more evidence of autoimmune and immune complex disorders, and have a higher incidence of cancer than do younger people. In addition, the immune system of older adults is less likely to respond appropriately to immunization. As a result, older adults have a weakened response to vaccination. Older adults also frequently have many comorbid conditions that impair normal immune function and compromise the immune response.
