Unit 4: (Chapter 7 - Altered Cellular Proliferation /Diffferentiation)

A client who is diagnosed with breast cancer asks the nurse why cancer causes tumors to form. Which statement is the nurse's best response? "Not all cancers result in tumors. Leukemia is an example of a cancer without tumors." "The cancer cells are much larger than normal cells, creating greater bulk in the tissues." "Cancer cells differ from normal cells because they can divide an unlimited number of times." "All cancers behave differently. You should speak to the health care provider about your case."

"Cancer cells differ from normal cells because they can divide an unlimited number of times." The best response should inform the client in simple terms why tumors develop, which is due to the uncontrolled growth (cell division) of cancer cells. This simple aspect of the biology of cancer is not unique to the client's case, so the nurse should not just dismiss the question by referring the client to the health care provider. Cancer cells multiply in number, they are not necessarily larger than normal cells. Although leukemia does not produce solid tumors, the production of leukemia cells is still considered uncontrolled growth, and sometimes referred to as "liquid tumors." Regardless of this fact, it is not relevant to the client's situation, so is not the best response.

The nurse is performing a health history for a male client who is having a series of diagnostic tests to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion? "Do you work in construction and have you been digging soil?" "Have you been around any chemicals that may have been inhaled?" "Do you have a history of smoking, and if so, how much?" "Do you have a history of cancer in your family?"

"Do you have a history of smoking, and if so, how much?" Squamous cell carcinoma is found most commonly in men and is closely correlated with a smoking history.

Diagnostic testing has resulted in a diagnosis of small cell lung cancer (SCLC) in an older adult client. When exploring the etiology of the client's disease, what assessment question is most relevant? "Have you ever been exposed to radiation during your working life?" "Do you have chronic obstructive pulmonary disease?" "Is there any history of cancer among your grandparents, parents, or siblings?" "Have you ever been a smoker?"

"Have you ever been a smoker?" Most cases of SCLC are attributable to smoking, and it is rare among nonsmokers. Family history and radiation exposure are relevant risk factors, but smoking exceeds their importance. Smoking also causes COPD, but COPD is not an independent risk factor for smoking.

A nursing student is caring for a client who was recently diagnosed with breast cancer. The student is explaining what the doctor meant when the term "sentinel node" was mentioned. What will the student tell the client? "Sentinel node is used to describe which node the cancer goes to last." "Sentinel node is used to describe that all lymph nodes will be affected." "Sentinel node is used to describe the initial lymph node to which the primary tumor drains." "Sentinel node is used to describe the last lymph node to which the primary tumor will drain."

"Sentinel node is used to describe the initial lymph node to which the primary tumor drains."

Which response by the nurse would be most accurate when a client with cancer asks why he feels so fatigued? "You are not getting enough rest." "It is happening because you are not eating enough." "It is a result of your depression and anxiety." "The disease and treatment can cause you to feel like this."

"The disease and treatment can cause you to feel like this." Fatigue is one of the most frequent side effects experienced by persons with cancer and occurs both as a consequence of the cancer itself and as a side effect of cancer treatment. It is characterized by feelings of tiredness, weakness, and lack of energy and is distinct from the normal tiredness experienced by healthy individuals in that it is not relieved by rest or sleep. It may also be an early symptom of malignant disease. The other options may contribute to the fatigue but are not a direct cause.

While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best? "The earliest symptoms relate to a chronic cough and shortness of breath." "If you start losing weight without trying and coughing up thick, yellow sputum, you should seek medical attention." "If you wake up with dried blood on your pillow, call your doctor right away." "When you can no longer get up or have the energy to go to work [fatigue], you should make an appointment with your physician."

"The earliest symptoms relate to a chronic cough and shortness of breath." The earliest symptoms usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. Later symptoms include coughing up blood, extreme fatigue, and weight loss.

The neonate displays a yellow discoloration of her skin on the second day of life. The neonatologist explains this condition to the parents. Which statement is most accurate? "Breast-feeding will not affect the bilirubin levels." "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus." "Most neonatal jaundice resolves spontaneously after about 6 weeks."

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

A nurse is caring for a client who has a laceration on the forearm. The client reports swelling and pain. Which statement is used in teaching about the condition? "There is a release of histamine, leukotrienes, and prostaglandins." "There is a release of dopamine, serotonin, and norepinephrine." "The pain indicates there is an infection." "The swelling is caused by chemotactic mediators."

"There is a release of histamine, leukotrienes, and prostaglandins."

A client with infectious mononucleosis asks the nurse why the lymph nodes are enlarged. Which statement is the nurse's appropriate response? "Your lymph nodes trap and destroy viruses." "Your lymph nodes are blocked and need to be drained." "Your lymph nodes are infected and should be removed." "Your lymph nodes multiply to fight infection."

"Your lymph nodes trap and destroy viruses."

Which client of a primary care physician would not require extra screening for cancer? A 51-year-old woman whose grandmother died of breast cancer A 50-year-old male who is obese and has a low-fiber, high-fat diet. A 48-year-old man who takes immunosuppressant drugs following a kidney transplant. A 38-year-old female with Down syndrome and congenital scoliosis

A 38-year-old female with Down syndrome and congenital scoliosis While a family history of cancer, immunosuppression, and poor diet are all associated with cancer, congenital and chromosomal abnormalities are not noted to represent an increased risk.

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? The neoplastic cells in the tissue sample have achieved their maximum size. A large proportion of the cells in the sample are actively dividing. Embryonic stem cells are present in the sample and represent a high risk for tumor growth. The doubling time of the mass is increasing.

A large proportion of the cells in the sample are actively dividing. The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. A high growth fraction represents a large proportion of growing cells, but does not necessarily mean that every cell is dividing. Stem cells would not be present in a sample from this location. Growth fraction does not imply a particular size of the cells.

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? The doubling time of the mass is increasing. Embryonic stem cells are present in the sample and represent a high risk for tumor growth. The neoplastic cells in the tissue sample have achieved their maximum size. A large proportion of the cells in the sample are actively dividing.

A large proportion of the cells in the sample are actively dividing. The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. A high growth fraction represents a large proportion of growing cells, but does not necessarily mean that every cell is dividing. Stem cells would not be present in a sample from this location. Growth fraction does not imply a particular size of the cells.

A client who has undergone a liver transplant 7 weeks ago has developed the following assessment data: ALT/AST elevation; jaundice of skin and sclera; weight gain with increase in abdominal circumference; and low-grade fever. The nurse suspects: Hyperacute graft rejection Acute graft rejection Chronic rejection Atherosclerosis of arteries of the liver

Acute graft rejection

Based solely on the inheritable condition, a child with Down syndrome is susceptible for developing which type of cancer? Kidney cancer Brain cancer Acute lymphocytic leukemia (ALL) Non-Hodgkin lymphoma

Acute lymphocytic leukemia (ALL) There are some inheritable conditions that increase susceptibility to childhood and even adult cancer. An example is Down syndrome, which increases the risk of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). The other cancers listed are not known to be associated with the diagnosis of Down syndrome.

The nurse is performing an assessment on a client with a diagnosis of folate deficiency. Which assessment finding(s) does the nurse anticipate? (Select all that apply.) Hypocalcemia Increased risk for bleeding Anemia Decreased appetite Weakness

Anemia Decreased appetite Weakness Folate plays a key role in the formation of red and white blood cells in the bone marrow and amino acid and nucleotide metabolism. A folate deficiency therefore may cause the nurse to anticipate weakness, decreased appetite, and anemia. Hypocalcemia is more closely associated with a vitamin D deficiency. Vitamin K deficiency may lead to increased risk for bleeding.

The nurse is caring for a client with an iron deficiency. Which assessment finding(s) does the nurse anticipate? (Select all that apply.) Anemia Joint pain Abdominal pain Hair loss Diabetes mellitus

Anemia Hair loss Due to being essential for multiple physiologic processes, iron deficiency may lead to numerous symptoms including hair loss, and may lead to anemia if not corrected. Joint pain, abdominal pain, and diabetes mellitus are all findings consistent with iron excess, not iron deficiency.

The nurse is assessing a client with a diagnosis of a cobalamin deficiency. Which assessment finding(s) does the nurse anticipate? (Select all that apply.) Anemia Peripheral neuropathy Increased risk for bleeding Hair loss Hypocalcemia

Anemia Peripheral neuropathy Cobalamin deficiency may present with anemia and neuropsychiatric syndromes such as peripheral neuropathy. Hair loss is more closely related to biotin deficiency. Hypocalcemia may occur in clients who are deficient in vitamin D. Vitamin K deficiency may lead to an increased risk for bleeding.

A client is suspected to have autoimmune gastritis. Which finding on the pathology report would be a positive diagnosis of this condition? Parietal cells Cellular toxins Anti-IF antibodies Monoclonal antibodies

Anti-IF antibodies

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation? Analgesics and use of a pneumatic compression device Massage followed by vascular surgery Frequent ambulation and the use of compression stockings Anticoagulation therapy and elevation of the leg

Anticoagulation therapy and elevation of the leg

The nurse is planning care for a client with acute lymphoblastic leukemia (ALL). Which intervention(s) will the nurse include in the plan of care? Select all that apply. Cluster care delivery to allow for rest periods throughout the day. Assess for peripheral edema daily and urine output hourly. Instruct client to wear a medical mask when leaving the hospital room. Report any elevation in white blood cell count to the health care provider. Assess the frequency and appearance of bowel movements each shift.

Assess for peripheral edema daily and urine output hourly. Report any elevation in white blood cell count to the health care provider.

Which type of a hypersensitivity reaction involves failure of the development of self-tolerance? Immediate hypersensitivity reaction Antibody-mediated reaction Immune complex reaction Autoimmune reaction

Autoimmune reaction

The early management recommendations for an asymptomatic person confirmed to have HIV antibodies would consist of which intervention? Immediately starting antiviral medications Baseline screening for viral load and CD4+ counts Quarantine to a special AIDS unit Administration of intravenous anti-infective medications

Baseline screening for viral load and CD4+ counts

A nurse interpreting a pathology report that indicates a client has an adenoma determines that the client's tumor is considered: Malignant Benign Apoptotic Differentiated

Benign The nurse should interpret the adenoma as a benign tumor that originated in epithelial glandular tissue. Malignant tumors are differentiated. Apoptosis is a form of programmed cellular death.

The nurse is conducting a community class on the importance of early recognition of cancer. Screening mechanisms are available for which cancers? Select all that apply. Cervical Pancreatic Lung Breast Prostate

Cervical Prostate Breast Explanation: Cervical cancer is screened for with a Pap smear, while breast cancer can be screened with a self-examination monthly. Prostate cancer is screened with PSA testing. Currently, neither pancreatic nor lung cancers have a definitive screening mechanism.Page 147

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which factor most likely had the greatest impact on development of the lung cancer? Air pollution Asbestos Cigarette smoke Radiation

Cigarette smoke Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

The nurse is caring for a client exhibiting anemia, mood changes, and peripheral neuropathy. Which nutritional deficiency should the nurse suspect? Vitamin C Biotin Cobalamin Vitamin K

Cobalamin Cobalamin deficiency may lead to neuropsychiatric findings and anemia. Biotin deficiency may lead to hair loss and skin changes. Vitamin C plays a key role in protection against infection. A vitamin K deficiency may lead to an increased risk for bleeding.

Several cancers have been identified as inheritable through an autosomal dominant gene resulting in people who inherit these genes being at increased risk for developing the cancer. Which cancer carries the highest risk of developing the cancer in someone who carries the gene? Colon cancer Osteosarcoma Acute lymphocytic leukemia (ALL) Retinoblastoma

Colon cancer Familial adenomatous polyposis of the colon also follows an autosomal dominant inheritance pattern. It is caused by mutation of another tumor suppressor gene, the APC gene. In people who inherit this gene, hundreds of adenomatous polyps may develop, some of which inevitably become malignant. Retinoblastoma is inheritable through an autosomal dominant gene, but only about 40% of retinoblastomas are inherited. Osteosarcoma and ALL are not inheritable through an autosomal dominant process.

The nurse is admitting a client whose medication administration record includes a weekly injection of erythropoietin (EPO). Which nursing consideration should be associated with this medication? Consider the possibility that the client has a diagnosis of chronic renal failure. Ensure that the client has intravenous access for the administration of packed red blood cells. Assess the client oxygen saturation level hourly and anticipate a prescription for arterial blood gases. Implement isolation precautions and ensure that staff and visitors comply with the precautions.

Consider the possibility that the client has a diagnosis of chronic renal failure.

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

CorrectA: "Try to minimize fat and maximize fiber when you're planning your meals." A low-fat, high-fiber diet is thought to provide some protection from colon cancer. Organic foods, vitamin supplements, and avoidance of large amounts of complex carbohydrates may be components of a healthy diet, but their relationship to the risk of colon cancer is not noted.

The nurse is caring for a client with iron deficiency anemia. Which finding(s) will the nurse anticipate?

Decreased hemoglobin Decreased oxygen saturation A client who is deficient in iron will have decreased levels of hemoglobin. Although oxygen transport is inhibited in this client, oxygen saturation may be within normal range, as this refers to the percent of hemoglobin saturated with oxygen, and not the amount of hemoglobin in the body. The client's blood volume and carbon dioxide level may also be unaffected by iron deficiency anemia.

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate? The endocardium over an acute myocardial infarction The hepatic vein in chronic passive congestion of the liver Deep vein thrombophlebitis of the leg An atherosclerotic plaque in the aorta

Deep vein thrombophlebitis of the leg Deep vein thrombosis (DVT) may be a precursor to pulmonary embolism. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT.

A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?

Deep vein thrombosis Venous insufficiency with deep vein thrombus formation is characterized by pain, swelling [edema], and deep muscle tenderness. Fever, general malaise, and elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. Swelling may vary from minimal to maximal. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present with deep vein thrombosis.

A family consumed some undercooked hamburger at a picnic and has since developed bloody diarrhea. The nurse knows which of the following statements listed below is correct regarding the infectious process?

Exotoxins that damage vascular endothelial causing bleeding and low platelet counts. Exotoxins can allow organisms to produce hemorrhagic colitis, which can be fatal. It is characterized by vascular endothelial damage, acute RF, and thrombocytopenia (low platelet counts). Toxic cell walls are classified as endotoxins. The ability to survive immune responses characterizes evasive factors. Adhesion factors and invasive factors are not involved in this situation.

Which response by the nurse answers a client's question regarding the most common objective sign of systemic inflammation during the acute-phase response? Edema Palpable lymph nodes Fever Diarrhea

Fever

The nurse is caring for a client exhibiting anemia, decreased appetite, fatigue, and headaches. Which nutritional deficiency does the nurse suspect? Folate Ascorbic acid Vitamin D Vitamin E

Folate

A nurse on the oncology floor reads a client's chart and sees that the client was treated for an adenocarcinoma. What type of tissue composes this tumor? Stem cells Connective tissue Neurons of the central nervous system Glandular epithelium

Glandular epithelium The term "adenocarcinoma" denotes a malignancy of the glandular epithelium. CNS cancers usually begin with "neuro-" and there is no particular term used to denote a stem cell cancer. There are varied terms used to describe cancers of the connective tissue, depending on the tissue type.

One week after a client received a transplant the nurse notes that the skin shows a maculopapular rash on the hands and feet. The client reports itching and nausea. What is the likely cause of these manifestations? Anaphylactic reaction Graft-versus-host disease Immunodeficiency disorder Opportunistic infection

Graft-versus-host disease

Which one of the following hemoglobin types is produced during sickle cell crisis?

HbS

Which clinical assessment findings can be considered an adverse effect to the radiation treatment the client is undergoing to "shrink" a tumor prior to surgery? Select all that apply. Urine output less than 30 mL/hr (low) Increased production of nasal secretions Stiff, painful joints in the AM Hemoglobin 9.0 g/dL (90 g/L)(low) Complains of frequent nauseas and vomiting

Hemoglobin 9.0 g/dL (90 g/L)(low) Complains of frequent nauseas and vomiting

A nurse is conducting a community education program on birth defects. The nurse determines that the participants need to learn more when they state that _______ is an autosomal recessive disorder. Cystic fibrosis Hemophilia A Phenylketonuria Sickle cell disease

Hemophilia A

A nurse doing a presentation on cancer to a local community group identifies which factors to be high-risk and associated with cancer development? Select all that apply. Low weight Environmental agents Number of siblings Immunologic mechanisms Hormonal factors Heredity

Heredity Hormonal factors Environmental agents Immunologic mechanisms Explanation: Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents. Obesity has also been suggested to a factor.Page 144

The clinic nurse suspects the client is having a genetically determined hypersensitivity to common environmental allergens since the client is experiencing which clinical manifestations? Select all that apply. Hives (urticaria) Runny nose Diarrhea Topical pustules Wheezes

Hives (urticaria) Runny nose Wheezes

The nurse is teaching a client with sickle cell anemia about hydroxyurea. Which information will the nurse include? Select all that apply. This medication works by killing bone marrow cells to promote new cell creation. Hydroxyurea leads to a greater production a type of hemoglobin that does not sickle. This medication can help decrease the symptoms of sickle cell anemia. Hydroxyurea targets red cells containing the sickling factor, reducing the total number. Hydroxyurea transforms affected hemoglobin molecules into healthy forms of hemoglobin.

Hydroxyurea leads to a greater production a type of hemoglobin that does not sickle. This medication can help decrease the symptoms of sickle cell anemia. Hydroxyurea transforms affected hemoglobin molecules into healthy forms of hemoglobin.

The nurse is assisting a new mother with breastfeeding. What does the nurse understand is a primary secretory immunoglobulin (Ig) that is found in the colostrum? IgD IgM IgA IgE

IgA

The nurse is providing care for a client whose abrupt-onset hypersensitivity reaction was stimulated by an antigen challenge. The nurse should understand that this reaction is: IgE-mediated. antibody-mediated. complement-mediated. T-cell-mediated.

IgE-mediated.

A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?

Ischemic stroke Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis or status epilepticus.

A client has been diagnosed with cancer that was a result of dysfunctional apoptosis. The health care provider explains the process to the multidisciplinary client care team. Select the best explanation. It increases the risk for mitochondrial dysfunction. Cells that go through apoptosis are the only ones that become cancerous. Apoptosis has no impact on malignant development. It allows for DNA-damaged cells to survive.

It allows for DNA-damaged cells to survive. Apoptosis is considered a normal cellular response to DNA damage; loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive.

When caring for a client with a pressure injury, the nurse collaborates with the provider to obtain a prescription for which of these interventions to promote wound healing? Keep dressing of the wound bed moist. Keep wound open to air to allow necrotic tissue to slough off. Increase dietary potassium consumption. Compress the wound with a pressure bandage.

Keep dressing of the wound bed moist.

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating? Thrombocytosis Neutropenia Non-Hodgkin disease Leukemia Hodgkin disease

Leukemia The finding of blast cells in the bone marrow is indicative of leukemia, particularly acute leukemias.

A nurse educator is explaining to a group of students the differences between leukemias and lymphomas. With respect to classification of these diseases, which explanation is most accurate?

Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures.

A nursing student who is studying cancer cells identifies which of the following to be the best definition of anaplasia? Decreased proliferation of cancer cells Increased cell differentiation in cancerous tissue Loss of cell differentiation in cancerous tissue Rapid proliferation of cancer cells

Loss of cell differentiation in cancerous tissue Explanation: The term "anaplasia" is the loss of cell differentiation in cancerous tissue. Rapid proliferation of cancer cells refers to a rapid increase in number of cells, while decreased proliferation is a decrease in the growth or decrease in the number of cells. An increase in cell differentiation refers to the process by which a less specialized cell becomes a more specialized cell type. This is not what happens during anaplasia. Page 132

A client with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia following an opportunistic infection. Which action would the nurse correlate with the client's risk for having developed this while developing another infection? Administration of prophylactic antibiotics Supplementary oxygen along with administration of bronchodilators Administration of antiretroviral medications Low CD4+ T-cell count

Low CD4+ T-cell count

Which cancer is the leading cause of cancer death? Breast Prostate Lung Colon

Lung Lung cancer is the leading cause of cancer deaths in men and women in the United States.

The nursing student who is studying about cancer correctly identifies which type to be the leading cause of cancer death in both men and women? Skin cancer Lung cancer Breast cancer Prostate cancer

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.

The nurse is caring for a client with sickle cell disease. When planning care, the nurse prioritizes which treatment goal because it best prevents sickling of the red blood cells? Maintain a positive fluid balance of at least 500 ml. Ensure adequate rest and 8 hours of sleep per night. Control pain to less than 4 on a scale of 0 to 10. Maintain an oxygen saturation above 92%.

Maintain an oxygen saturation above 92%. Sickling is triggered by low oxygen tension levels. All the listed actions can help prevent sickling by maintaining a balance between tissue oxygen demand and supply. However, hypoxemia—as indicated by a low oxygen saturation—is most likely to result in sickling. Adequate hydration, pain control, and rest will also help prevent sickling but are not as critical as preventing hypoxemia.

A nurse who is caring for a client with liposarcoma plans care for a client with: Malignant tumor of adipose tissue Benign tumor of the bone Malignant tumor of smooth muscle Benign tumor of fibrous tissues

Malignant tumor of adipose tissue The nurse should plan care for a client with a malignant tumor of adipose tissue.

A client who has just recently been diagnosed with cancer asks the nurse what tumor markers are. Which answer would be the nurse's best response? Markers are antigens expressed on the surface of tumor cells. Markers are enzymes released by the body to prevent cancer. Markers are marks the physician places to show the site of the cancer. Markers are doses of vitamins used to fight cancer.

Markers are antigens expressed on the surface of tumor cells Tumor markers are antigens expressed on the surface of tumor cells or substances released from normal cells in response to the presence of a tumor.

An obstetrics nurse is counseling an expectant mother. The mother is concerned about letting people hold her baby once the baby is born, fearing that the infant will get sick. What should the nurse explain to the mother? Maternal immunoglobulins cross the placenta and protect the newborn early in life. IgA that is present at birth, and which originates with the mother, will protect the baby, Abundant lymphoid tissues protect the infant in the first few months of life. The innate immune system will protect the baby.

Maternal immunoglobulins cross the placenta and protect the newborn early in life.

The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which type of anemia? Hemolytic anemia Sickle cell anemia Iron deficiency anemia Megaloblastic anemia Anemia of Chronic Disease

Megaloblastic anemia

Cancer prognosis has improved most dramatically when treatment plans include which of the following? Surgical procedures Multiple types of treatment Pinpointed radiation Aggressive chemotherapy

Multiple types of treatment Treatment plans that use more than one type of therapy, often in combination, are providing cures for a number of cancers that a few decades ago had a poor prognosis, and in turn are increasing the life expectancy. The remaining options can be components of a multi-pronged treatment plan.

Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues? Mutation Transformation Neoplasm Insertion

Neoplasm An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm. A transformation occurs when a cell has become cancerous. A mutation is an alteration in the DNA that may or may not result in a transformation. An insertion is a type of mutation.

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

Not crossed the basement membrane, so it can be surgically removed with little chance of growing back Cancer in situ is a localized preinvasive lesion. As an example, with breast ductal carcinoma in situ, the cells have not crossed the basement membrane. Depending on its location, an in situ lesion usually can be removed surgically or treated so that the chances of recurrence are small. For example, cancer in situ of the cervix is essentially 100% curable.

A client presents with fatigue and a temperature of 101.3°F (38.5°C). The client also has several bruises at varying degrees of healing and reports 10 lb (4.5 kg) unintentional weight loss in the past 2 months. Which assessments will the nurse perform to help identify the possible cause of these symptoms? Select all that apply.

Palpate lymph nodes. Draw blood for compete blood count (CBC). Ask about recent history of infections. The client is exhibiting clinical manifestations of either acute or chronic leukemia, so the nurse should focus the assessment on additional evidence of these conditions. Supporting evidence of leukemia includes fatigue, lymph node enlargement, low-grade fever, and recurrent infections. Therefore, the nurse palpates lymph nodes, examines the complete blood count for an elevated white blood cell count or low platelet level associated with leukemias, and interviews the client about recent infections. A fasting blood glucose level is relevant to diagnosing diabetes, which can result in weight loss but is not associated with fever and bruising. Hearing loss is not associated with a priority diagnosis that aligns with the client's presenting symptoms.

What is the main effect of HIV infection? Poor natural killer cell function Poor B-cell function Poor suppressor T-cell function Poor helper T-cell function

Poor helper T-cell function

A child has a congenital condition in which the thymus gland is absent. Which information should the nurse include as the priority when providing caregiver education? Observe and report any signs of bleeding. Practice strict infection control practices. Report if the child has 2 to 3 loose stools in a day. Feed in an upright position, due to high risk for aspiration.

Practice strict infection control practices.

The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease? Produce erythropoietin Produce renin Produce angiotensin Inactivate vitamin D

Produce erythropoietin Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa), produced through DNA technology, to stimulate erythropoiesis.

Heparin is an anticoagulant given by injection to prevent the formation of blood clots. How does heparin work? Binds to factor X Promotes the inactivation of clotting factors Binds to factor XIIa Promotes the inactivation of factor VIII Inhibits Vitamin K

Promotes the inactivation of clotting factors

While studying cancer, nursing students learn about the process by which cancer-causing agents cause normal cells to become cancerous. This process is a multi-step mechanism that can be divided into three stages, which include which of the following? Select all that apply. Promotion Termination Initiation Evaluation Progression

Promotion Progression Initiation Explanation: The process by which carcinogenic agents cause normal cells to become cancerous is a mechanism that are divided into three stages: initiation, promotion, and progression.Page 147-149

Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects? Circulating hormone levels Rapidly proliferating cells Cell-surface receptors Blood vessels

Rapidly proliferating cells Chemotherapy and radiation treatment both preferentially affect rapidly proliferating cells, which includes some normal body cells, such as epithelial and hair-follicle cells, as well as cancer cells.

A client has been diagnosed with aplastic anemia. The nurse correlates this diagnosis with which laboratory value? Relative polycythemia Increased hemoglobin counts Increased mean corpuscular volume (MCV) Reduction of white blood cells

Reduction of white blood cells Aplastic anemia is caused by bone marrow suppression and usually results in a reduction of white blood cells and platelets, as well as red blood cells. Chronic diseases such as inflammatory disorders (rheumatoid arthritis), cancers, and renal failure cause anemia through the production of inflammatory cytokines that interfere with erythropoietin production or response.

A male client with chronic obstructive pulmonary disease has a hematocrit of 55%. The practitioner tells the client that he has: Primary polycythemia Secondary polycythemia Polycythemia vera Chronic Myelogenous Leukemia

Secondary polycythemia

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

Taking tissue biopsy and looking for abnormal cells Tissue biopsy involves the removal of a tissue specimen for microscopic study. It is of critical importance in designing the treatment plan should cancer cells be found. Biopsies are obtained in a number of ways, including needle biopsy; endoscopic methods, such as bronchoscopy or cystoscopy, which involve the passage of an endoscope through an orifice and into the involved structure; and laparoscopic methods.

The nurse is caring for a client who is diagnosed as having sickle-cell trait (SCT). What is the nurse's focus when providing care? Teach the client how to avoid sickling crises. Teach the client about genetic counseling options. Assess the client's current oxygen and hemoglobin levels. Prevent infection and ensure up-to-date immunizations.

Teach the client about genetic counseling options.

The nurse is caring for a client who has just been diagnosed with stage II non-small cell lung carcinoma (NSCLC). How should the nurse explain this stage of cancer to the client? The cancer is in the lung and nearby lymph nodes. The cancer is in the lung and distant lymph nodes. The cancer is located in the tissue of both lungs. The cancer is in the lung and the fluid surrounding the same lung.

The cancer is in the lung and nearby lymph nodes. Staging of lung cancer is divided into four levels. These are based on whether the cancer has spread from the lungs to the lymph nodes or other organs. In stage II, the cancer is in the lung and nearby lymph nodes. Stage I means the cancer is localized to a single lung only. In stage III, the cancer has spread to the nodes in the middle of the chest (mediastinal lymph nodes). If cancer cells have infiltrated the pleural fluid surrounding the lung, this meets the criteria for stage IV. Most people with lung cancer are diagnosed at stages III and IV due to the insidious onset and high prevalence of early metastases in lung cancer.

An elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a candy bar containing peanuts. Which statement best describes the child's current status and preferred treatment? The child is experiencing shortness of breath caused by potent vasoconstriction, which can be relieved by epinephrine injection. The child is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine. The child's mast cells and basophils have been sensitized, but systemic effects can be mitigated by administration of bronchodilators. The child is likely in a primary- or initial-stage allergic response that can be relieved by antihistamine administration.

The child is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine.

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

The tumor will grow by expansion and is likely encapsulated. Benign neoplasms typically grow by expansion rather than invasion. As well, they are usually contained within a fibrous capsule. Malignant tumors are associated with undifferentiated cells, metastasis, and infiltration of surrounding tissue.

Select the statement that best describes the effectiveness of vaccination in the older adult population. Vaccination is less effective in inducing a full immune response in older persons compared to younger adults. Older adults who are immunized have the same effective response in immunity as younger persons do. Age does not influence the effectiveness; it depends on the amount of medication you receive. Vaccinations are only effective in older adult populations if their families have been vaccinated.

Vaccination is less effective in inducing a full immune response in older persons compared to younger adults.

The nurse is orienting a student to the oncology setting. Which characteristic does the student identify as one that is representative of a benign tumor? Rapid replication Undifferentiated cells A fibrous capsule Distant infiltration

a fibrous capsule Because benign tumors have slow cell replication and growth, they develop a surrounding rim of compressed connective tissue called a fibrous capsule. Benign tumors encapsulate and are incapable of distant metastasis. Benign tumors have mature, differentiated cells but they have lost the ability to suppress cell proliferation.

Following the birth of a healthy newborn weighing 3860 grams, the client reports dizziness and lightheadedness. The nurse assesses a large quantity of lochia, bleeding around the IV site, and bleeding from the nose and mucous membranes. Which treatment option(s) does the nurse anticipate to treat this obstetrical complication known as disseminated intravascular coagulation (DIC)? Select all that apply. anticoagulants exogenous clotting factors antibiotics intravenous estrogens albumin infusion

anticoagulants exogenous clotting factors

The nurse discusses medications with a client with arterial thrombosis. Which medication category reduces platelet aggregation, thereby helping to restore blood flow to the heart muscle? losartan, an angiotensin II receptor blocker atenolol, a beta-blocker diltiazem, a calcium channel blocking agent aspirin (acetylsalicylic acid), a salicylate agent

aspirin (acetylsalicylic acid), a salicylate agent

A 10-month-old infant has begun to take his first steps and his mother has brought him for assessment because of swelling and bruising in his ankles and knees joints. The mother also states that he was eager to walk but has now regressed and cries when she tries to encourage it. The clinician should: prescribe a trial of desmopressin acetate (DDAVP) to rule out von Willebrand disease. order testing to rule out disseminated intravascular coagulation (DIC). administer vitamin K STAT. assess the child for signs and symptoms of hemophilia A. consult a social worker in regards to risk for child abuse

assess the child for signs and symptoms of hemophilia A.

A nursing student has learned in class that with abdominal cancer the tumor may compress the viscera, which will cause which of the following? Hemorrhoids Polyps Rectal bleeding Bowel obstruction

b. Bowel obstruction Explanation: Cancer as it grows can invade and compress adjacent structures. Abdominal cancer may compress the viscera and cause bowel obstruction.

The nurse is caring for a client newly diagnosed with acute myeloid leukemia (AML). When reviewing the client's medical record, the nurse notes which finding(s) is evidence of a favorable prognosis for the client? Select all that apply. being asymptomatic at the time of diagnosis having a lower number of immature while blood cells being 30 years of age at the time of diagnosis receiving intrathecal chemotherapy early in treatment course having a history of exposure to chemical carcinogens

being 30 years of age at the time of diagnosis having a lower number of immature while blood cells being asymptomatic at the time of diagnosis The prognosis for adults with acute myeloid leukemia (AML) is generally favorable, with about 70% attaining complete remission. Prognosis is improved in those who are younger and who have lower immature white blood cell counts at the time of diagnosis. If the client required intrathecal chemotherapy, this is evidence of central nervous system involvement, which confers a poorer prognosis. The fact that the client was asymptomatic suggests the lack of systemic infection at diagnosis, which is a positive prognostic indicator. Whether the client may have been exposed to chemical carcinogens is not relevant to the prognosis.

The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to report which symptom?

bone pain Bone pain is one of the first symptoms to occur in approximately 75% of all individuals diagnosed with multiple myeloma. Multiple myeloma presents primarily in the bones and bone marrow. The other choices are also signs and symptoms of the disease; however, they appear later as the disease progresses.

The nurse is caring for a client diagnosed with chronic lymphocytic leukemia (CLL). The client's initial white blood cell (WBC) count is 120,000/mm3 (120 × 109/l). The nurse prepares the client for which initial priority treatment? splenectomy radiotherapy chemotherapy intravenous antibiotics

chemotherapy Clients with chronic lymphocytic leukemia (CLL) who have extremely high circulating white blood cell (WBC) counts (greater than 100,000/mm3; 100 × 109/l) require immediate chemotherapy due to the risk of obstruction of blood vessels, which could cause organ ischemia or infarction. Although splenectomy may be required due to splenic enlargement, this would not be considered until after the WBC count was reduced using chemotherapy. The extreme elevation in WBC is not related to infection, so antibiotics are not the priority. Because the leukemia cells are nonfunctioning WBCs, the client is at greater risk for infection and antibiotics may be required if evidence of infection is present. Radiotherapy may also be used in CLL but, due to the client's high WBC count, chemotherapy will best reduce the circulating WBC level most quickly and is the priority.

The nurse works in an outpatient wound center. Which client presentation will result in documentation pertaining to wound healing by secondary intention? Select all that apply. client with wound on the lower calf resulting from the leg touching a motorcycle muffler client with stage 3 decubitus pressure injury that extends into the tissue beneath the skin, forming a small crater with fat showing in the sore client with a large abscess on the roof of the mouth following a root canal that is not healing with brushing of the teeth or gargling with mouthwash client who has diabetes and has undergone an abdominal surgery with well-approximated wound edges that are lined up close together child with a cut on the head from running into a table edge that resulted in the use of steri-strips to bring the edges together

client with wound on the lower calf resulting from the leg touching a motorcycle muffler client with stage 3 decubitus pressure injury that extends into the tissue beneath the skin, forming a small crater with fat showing in the sore client with a large abscess on the roof of the mouth following a root canal that is not healing with brushing of the teeth or gargling with mouthwash

A client arrives at the clinic with severe anemia and a hemoglobin level of 6.2 g/dl (62 g/L). The client states passing a large amount of bright red blood following passage of very narrow stools. The nurse suspects the cause of the bright red blood could be related to which pathophysiologic disease/illness? diverticulosis hemorrhoids outside of the anus colon cancer esophageal varices

colon cancer

A postpartum client develops uncontrolled postpartum bleeding, oozing from IV sites, a blood pressure of 82/40 mm Hg, and respiratory distress. Which complication does the nurse suspect is occurring? Thrombocytosis immune thrombocytopenic purpura (ITP) hemolytic disease of the newborn (HDN) disseminated intravascular coagulation (DIC)

disseminated intravascular coagulation (DIC)

A client is experiencing an inflammatory response to an unknown substance. Which manifestation(s) is considered a systemic response? Select all that apply. erythema of the skin edema localized to the exposure site swollen lymph nodes nearest to the exposure site elevated body temperature 101.4°F (38.5°C) white blood cells count of 14,000/mm3 (14 ×109/l) elevated C-reactive protein level

edema localized to the exposure site elevated body temperature 101.4°F (38.5°C) white blood cells count of 14,000/mm3 (14 ×109/l)

A client has traveled to many endemic areas. On arrival back to the United States, the client seeks medical attention for headaches, fatigue, fever/chills, and general body aches. Which laboratory value result(s) is highly suggestive of malaria? Select all that apply. elevated lactate dehydrogenase (LDH) test atypical lymphocytes low platelet count low hemoglobin level low amylase level elevated creatinine level

elevated lactate dehydrogenase (LDH) test atypical lymphocytes low platelet count low hemoglobin level The diagnosis of malaria is made through a history of travel to an endemic area, physical examination, and laboratory testing. Given the pathophysiology of malaria, which attacks proteins in red blood cells, hemoglobin levels are often low, as are platelet counts, and liver function tests are abnormal. A classical triad of thrombocytopenia elevated LDH (a liver enzyme), and atypical lymphocytes is a common presentation. Elevated creatinine levels occur with renal failure. Decreased levels can also be due to kidney disease and preeclampsia.

Select the option that best identifies how adult cancers differ in origin from childhood cancers. Adult cancers originate from: the hematopoietic system. embryonic cells. neuronal tissues. epithelial cells.

epithelial cells Adult cancers are typically of epithelial cell origin, while childhood cancers involve the hematopoietic system, nervous system, soft tissues, bone, and kidneys. Childhood cancers have a more primitive (embryonic) appearance.

During a "tumor board" meeting to discuss new cancer diagnoses, the pathologist was in attendance. What primary role does the pathologist provide for this meeting? Explain how to collect various samples and complications that may occur. Determine whether the tumor is amenable to chemotherapy. Discuss possible treatment options for a specific tumor. Explain findings after examining tissue samples.

explain findings after examining tissue samples Pathologists have advanced training in the cause and effect of diseases. They spend much of their careers examining tissues, organ samples, and laboratory samples of body fluids. Most pathologists work in a laboratory, hospital, or morgue and many play a role in determining the cause of death. The pathologist does not necessarily prescribe treatment options or whether certain chemotherapy should be prescribed. These actions are usually done by the oncologist. Pathologists also do not provide education on how to collect tissue samples, because collecting samples is usually done by the pathologist within the health care setting.

The nurse recognizes that both grading and staging are methods for classifying cancer and selecting a treatment plan. What is clinical staging used to determine? Histologic characteristics Extent and spread of the disease Number of mitoses Level of differentiation

extent and spread of the disease Tumor staging groups clients according to the extent and spread of the disease, using the TNM (tumor, node, and metastasis) system. Grading of cancer tumors is a determination of the level of differentiation and number of mitoses based on the tissue characteristics of the tumor cells, using grades I, II, III, and IV.

Which client(s) will the nurse assess closely for formation of blood clots? Select all that apply. female client using oral contraceptives client with chronic eosinophilic leukemia, a myeloproliferative disease client with a history of chronic obstructive pulmonary disease (COPD) client with systemic lupus erythematosus, an autoimmune disease client with anemia caused by renal disease

female client using oral contraceptives client with chronic eosinophilic leukemia, a myeloproliferative disease client with systemic lupus erythematosus, an autoimmune disease Disorders of excess clotting allow unregulated formation of thrombi throughout the body. Hypercoagulability can be congenital or acquired. Genetic mutations can result in excess coagulant factors or deficient anticoagulant mechanisms. Acquired causes of hypercoagulability include autoimmune mechanisms that activate platelets and alter coagulation factors such as systemic lupus erythematosus; certain types of cancer; myeloproliferative disorders such as chronic eosinophilic leukemia; and use of oral contraceptives. Clients with renal disease that causes anemia or with COPD are not at high risk for excess clotting of the blood.

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

growth factors Many tumors secrete growth factors, which trigger and regulate the angiogenesis process. Tumor cells express various cell surface attachment factors, for anchoring. Tumor cells secrete proteolytic enzymes to degrade the basement membrane and migrate into surrounding tissue. Cancer cells may produce procoagulant materials that affect clotting mechanisms.

A client's tissue biopsy reveals the presence of cells that appear to have abnormalities in shape and size. Carcinoma is suspected because these cells possess the characteristics of: loss of differentiation. angiogenesis. cell density-dependent inhibition. cohesiveness and adhesion.

loss of differentiation. The deviation from normal patterns of differentiation is a characteristic of cancer cells. Angiogenesis is also associated with malignancy, but this does not directly account for abnormalities in size and shape. Cohesiveness, adhesion, and cell density-dependent inhibition are characteristics of normal cells.

Which cellular abnormalities commonly appear in clients with HIV? lymphocytopenia (low lymphocyte count in peripheral blood) B-cell suppression macrocytosis excessive T-cell activity

lymphocytopenia (low lymphocyte count in peripheral blood)

Which laboratory value(s) leads the nurse to suspect the client has developed iron-deficiency anemia? Select all that apply. serum iron: 14 µg/dl (2.51 µmol/L), normal: 60 to 170 µg/dl (10.74 to 30.43 µmol/L) vitamin B12 level 150 pg/ml (110.67 pmol/l), normal level 190 and 950 pg/ml (140.18 to 700.91 pmol/l) mean corpuscular hemoglobin: 12 pg/cell, normal 27.5 to 33.2 pg/cell normocytic red blood cell size ferritin level: 9 µg/ml (9 mcg/L), normal 10 to 120 µg/ml (10 to 120 mcg/L)

mean corpuscular hemoglobin: 12 pg/cell, normal 27.5 to 33.2 pg/cell serum iron: 14 µg/dl (2.51 µmol/L), normal: 60 to 170 µg/dl (10.74 to 30.43 µmol/L) ferritin level: 9 µg/ml (9 mcg/L), normal 10 to 120 µg/ml (10 to 120 mcg/L) With iron-deficiency anemia, the nurse will see microcytic red blood cell size; low mean corpuscular hemoglobin; low serum iron; low ferritin level and a normal vitamin B12 level.

A client is being discharged following a percutaneous transluminal coronary angioplasty (PTCA) with stent placement. The nurse explains that the acetylsalicylic acid (ASA) and clopidogrel are both prescribed to reduce the risk of which complication?

stent occlusion Antiplatelet treatment with both ASA and clopidogrel are recommended for 1 year after stent placement to prevent thrombosis, which can lead to stent occlusion, a major risk of the procedure. Anticoagulants, not antiplatelet medications are used to prevent pulmonary embolism or cardioembolic stroke, and neither of these conditions are a complication of PTCA. Stent collapse is not a known issue after PTCA and antiplatelet medications would not affect stent collapse.

The nurse is assessing a client who presented with enlarged lymph nodes suspected of having Hodgkin lymphoma (HL). Which additional assessment data will the nurse collect related to the manifestations of HL? Select all that apply. temperature weight exercise tolerance urine appearance evidence of bruising

temperature weight exercise tolerance