CHAPTER 21 IGGY (ADAPTIVE QUIZZING)

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? 1 "My mother and grandmother had breast cancer, so I am at risk." 2 "I get a mammogram every 2 years since I turned 30." 3 "A clinical breast examination is performed every month since I turned 40." 4 "A computed tomography (CT) scan will be done every year after I turn 50."

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

When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? 1-Tobacco use 2- Ethnicity 3- Gender 4- Increased age

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

Which description about genetic screening is correct? 1-It identifies genetic risk for specific cancers. 2-The tests are performed on cerebrospinal fluid samples. 3-A positive test diagnoses cancer in the client. 4-The test results are shared with the client's family.

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

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? 1- Infection with hepatitis B virus 2- Consuming a diet high in animal fat 3- Exposure to radon 4- Familial polyposis

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

A client wishes to undergo genetic testing to determine cancer predisposition. What preliminary information does the nurse provide to this client about genetic testing? Select all that apply. 1 Genetic testing is expensive. 2 The test is performed on saliva. 3 The test is performed on blood. 4 It is helpful in diagnosing cancer. 5 Insurance usually covers the cost.

1, 2 Genetic testing is an expensive procedure that uses the client's blood to rule out a person's genetic risk for a few specific cancers. Genetic testing is helpful only in detecting the risk for cancer, not for diagnosing the presence of cancer. Insurance companies generally do not cover the cost of genetic testing.

A client asks if there are any drugs which help to prevent the development of cancer. How does the nurse respond? Select all that apply. 1 Aspirin (acetylsalicylic acid) reduces the risk of colon cancer. 2 Lycopene reduces the risk of prostate cancer. 3 Tamoxifen (Nalvodex) reduces the risk of breast cancer. 4 There are no drugs which prevent the development of cancer. 5 Anticancer drugs can be used as preventive therapy.

1, 2, 3 The drug therapies that have proven preventive roles for various cancers are aspirin for colon cancer, lycopene for prostate cancer, and tamoxifen for breast cancer. The client should not be encouraged to use anti-cancer drugs because they are associated with a higher risk for developing serious toxic effects. At the same time, they increase the risk of developing other cancers.

A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. 1 Brain 2 Bone 3 Lymph node 4 Kidney 5 Liver

1, 2, 3, 5 Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Kidneys are not a typical site of lung cancer metastasis.

The nurse includes which factors in teaching regarding the typical warning signs of cancer? Select all that apply. 1 Persistent constipation 2 Scab present for 6 months 3 Curdlike vaginal discharge 4 Axillary swelling 5 Headache

1, 2, 4 Change in bowel habits, a sore throat that does not heal, and a lump or thickening in the breast or elsewhere are all potential warning signs of cancer. Curdlike vaginal discharge represents a yeast infection. Headache is not a warning sign, but may be present with multiple problems.

What are the features of a normal cell? Select all that apply. 1 Low mitotic index 2 Anaplastic 3 Tight adherence 4 Euploidy 5 Migratory

1, 3, 4 At any given time, there are few actively dividing cells. Normal cells have a low mitotic index. Normal cells with the exception of red blood cells produce proteins that protrude from the membranes, allowing the cells to bind tightly together. This results in normal cells being nonmigratory and prevents cells wandering from one tissue to the next. Normal chromosomes or euploidy is a characteristic feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for human beings. Malignant cells or cancer cells are anaplastic; they lose the specific appearance of their parent cells. As a cancer cell becomes more malignant, it becomes smaller and rounded. They have large nuclear-to-cytoplasmic ratio. Normal cells have specific morphological features with small nuclear-to-cytoplasmic ratio. Cancer cells migrate because they have many enzymes on their cell surfaces and do not bind tightly to each other.

Which dietary modifications can the nurse recommend to a client for preventing cancer development? Select all that apply. 1- Increasing broccoli intake 2- Increasing red meat consumption 3- Consuming more dietary bran 4- Eating more sausage and bacon 5- Restricting alcohol consumption to less than 2 drinks per day

1, 3, 5 The dietary modifications that can help in reducing cancer development include eating broccoli, cauliflower, sprouts, cabbage, and dietary bran. Restricting alcohol consumption to less than 2 drinks per day also reduces the risk of developing cancer. Consuming animal fats like red meat, sausage, and bacon increase the risk for developing cancer, so their consumption should be restricted.

A client is at risk for developing colon cancer. What are the various preventive interventions that the nurse may plan to implement? Select all that apply. 1 Suggest taking aspirin. 2 Administer the vaccine Gardasil. 3 Encourage a diet rich in fiber and fat. 4 Suggest limiting the number of sexual partners. 5 Refer for a polypectomy if the client has associated polyps.

1, 5 Clients who are at risk for developing colon cancer may begin taking aspirin, and removing at-risk tissues like associated polyps, if present, to reduce their risk. Gardasil is a vaccine effective against cervical cancer. The client should be encouraged to have a diet rich in fiber and low in fat. Limiting sexual partners is a practice helpful in preventing cervical cancer.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? 1 Easy bruising 2 Dyspnea 3 Night sweats 4 Chest wound

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

Which activity performed by the community health nurse best reflects primary prevention of cancer? 1- Assisting women to obtain free mammograms 2- Teaching a class on cancer prevention 3- Encouraging long-term smokers to get a chest x-ray 4- Encouraging sexually active women to get annual Papanicolaou (Pap) smears

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

The nurse is assessing a client for bladder cancer. About which sign or symptom does the nurse ask the client? 1- Unexplained fevers 2- Presence of blood in the urine 3- History of urinary tract infections 4- Change in the size of urine stream

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

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? 1- Vomiting 2- Back pain 3- Frequent urination 4- Cyanosis of the toes

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

A client has a very high risk for developing breast cancer. What preventive measures may the nurse recommend? Select all that apply. 1 Encourage a diet rich in fiber and fat. 2 Discuss the need for a mastectomy. 3 Suggest the long-term use of vitamin D. 4 Explain the need for long-term use of tamoxifen. 5 Recommend limiting the number of sexual partners.

2, 3, 4 Preventive measures for clients who are at high risk for developing breast cancer include the removal of the breast (mastectomy), and long-term intake of vitamin D and tamoxifen. The client should be encouraged to consume a diet rich in fiber and low in fat. Limiting the number of sexual partners is helpful in preventing cervical cancer, not breast cancer.

A client who is hospitalized has been diagnosed with Epstein-Barr viral infection. What are future malignancies that the client is at risk for developing? Select all that apply. 1 Cervical cancer 2 B-cell lymphoma 3 Burkitt's lymphoma 4 Primary liver cancer 5 Nasopharyngeal carcinoma

2, 3, 5 The Epstein-Barr virus predisposes the client to developing B-cell lymphoma, Burkitt's lymphoma, and nasopharyngeal carcinoma. Human papilloma viral infection is a risk factor for cervical cancer. Hepatitis B and C infections are risk factors for primary liver cancer.

The TNM classification report of a client with lung cancer is TisN0Mx. How is this classification interpreted? Select all that apply. 1 No metastasis. 2 Carcinoma in situ. 3 No evidence of the primary tumor. 4 Involvement of regional lymph nodes. 5 Presence of metastasis cannot be assessed.

2, 5 Staging determines the exact location of the cancer and its degree of metastasis at diagnosis. The acronym TNM refers to "Tumor, Nodes, Metastasis." Per the TNM classification, Tis stands for carcinoma in situ. Mx means that the presence of distant metastasis cannot be assessed. The absence of regional lymph node metastasis is indicated by N0.

The nurse is teaching a client about cancer warning signs. Which signs/symptoms does the nurse include? Select all that apply. 1- A sore that heals quickly 2-Unusual bleeding and discharge 3- Change in bowel or bladder habits 4-Nagging cough or a hoarse voice 5-Long-lasting warts without any observable change

2,3,4 Unusual bleeding and discharge can be a warning sign for the onset of cancer. A change in bowel or bladder habits may be indicative of a malignancy in the intestine and urinary bladder, respectively. Nagging cough or hoarseness can indicate a malignancy of the respiratory airways. A sore that heals quickly indicates an effective wound-healing mechanism, while a non-healing sore can be a cancer warning sign. Long-lasting moles or warts with observable changes may be a warning sign for cancer.

What are the common cancers related to tobacco use? Select all that apply. 1- Cardiac cancer 2-Lung cancer 3-Cancer of the tongue 4-Skin cancer 5-Cancer of the larynx

2,3,5 Organs exposed to the carcinogens in tobacco are the most likely to develop cancer. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other UV exposure such as that found with tanning beds.

What is a known cause of skin cancer? 1- Intake of nitrites 2- Cigarette smoke 3- Tanning beds 4- Low-fiber diet

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

How is the migratory feature of cancer cells explained? 1 They have a large nuclear-to-cytoplasmic ratio. 2 They lose their specific functions. 3 They do not make fibronectin. 4 They have a short generation time.

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

What are the features of benign tumor cells? Select all that apply. 1 They exhibit aneuploidy. 2 They have migratory tendency. 3 They have orderly growth patterns. 4 They grow by hyperplastic expansion. 5 They are encapsulated by fibrous connective tissue.

3, 4, 5 Benign tumor cells have orderly growth patterns. They grow by hyperplastic expansion, causing the tissue to increase in size by increasing the number of cells. Growth may continue beyond an appropriate time or occur in the wrong place, but the growth rate is normal. They continue to make fibronectin and adhere to each other tightly. They are encapsulated by fibrous connective tissue which prevents them from migrating. Abnormal chromosomes or aneuploidy are common in cancer cells as they become more malignant. Benign cells have normal chromosomes. Cancer cells have a migratory tendency as they are not bound to each other with fibronectin.

A client is diagnosed with familial polyposis. Which cancer may the client be at risk for developing in the future? 1- Meningioma 2- Breast cancer 3- Gonadal cancer 4- Colorectal cancer

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

Which type of cancer has been associated with Down syndrome? 1-Breast cancer 2-Colorectal cancer 3-Malignant melanoma 4-Leukemia

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

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? 1-"Cigarette smoking always causes lung cancer." 2-"Taking multivitamins will prevent me from developing cancer." 3-"If I have only one shot of whiskey a day, I probably will not develop cancer." 4-"I need to report the pain going down my legs to my health care provider."

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