RNSG 1343 Complex Concepts of Adult Health Ch 21 Evolve

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult patient indicates understanding of the nurse's instructions?

"I need to report the pain going down my legs to my health care provider." (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.)

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the patient indicates understanding of the nurse's instructions?

"My mother and grandmother had breast cancer, so I am at risk." (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 patient 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 patients with a strong family history.)

A 72-year-old patient recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?

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

A patient who is hospitalized has been diagnosed with Epstein-Barr viral infection. What are future malignancies that the patient is at risk for developing? Select all that apply.

B-cell lymphoma Burkitt's lymphoma Nasopharyngeal carcinoma (The Epstein-Barr virus predisposes the patient 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.)

Which hepatitis viruses may cause liver cancer? Select all that apply.

B. C. (Being infected with the hepatitis B or C virus can cause the development of primary liver cancer. Hepatitis A and E cause acute illness which is usually resolved with supportive therapy without any long-term effects. Hepatitis D virus does not cause any single illness; however, it may cause liver disorders only if there is co-infection with the hepatitis B virus.)

Which statements about benign and malignant tumors are correct? Select all that apply.

Benign tumors grow by expansion. Malignant tumors grow by invasion. Overexpressed oncogenes may lead to the development of cancer. (Benign tumors grow at a slow pace by expansion while malignant tumors grow at a faster pace by invasion. Oncogenes that are overexpressed can lead to the transformation of normal cells into malignant cells. Cancer cells lose the ability of apoptosis, causing their programmed cell death mechanism to become deficient. Malignant transformation, even in a single cell, can initiate the development of cancer.)

The pathology report of a patient with cancer shows that the cells have broken off from the main tumor. The enzymes on the surface of the tumor cells are allowing cancer cells to enter blood vessels and travel around the body. The nurse recognizes that which step of metastasis is described in the pathology report?

Blood vessel penetration (Metastasis occurs when cancer cells move from the primary site to other sites. During the blood vessel penetration step, the cancer cells break off from the main tumor. Cancer cells enter into the blood vessel by making holes with the help of an enzyme on the surface of tumor cells. During the arrest and invasion step, cancer cells clump up in blood vessel walls and invade new tissue areas. In the tumor vascularization step, cancer cells secrete a tumor angiogenesis factor that stimulates the blood vessels to bud and form new channels. Malignant transformation is the first step of metastasis; normal cuboidal cells undergo malignant transformation and divide enough times to form a tumor.)

What is the most common site for the metastasis of lung cancer?

Brain (The most common site for the metastatic spread of lung cancer is the brain. Lung cancer may also spread to the bones, liver, pancreas, and lymph nodes; however, the spread to these organs is at a lesser incidence compared to brain metastasis.)

A patient is diagnosed with familial polyposis. Which cancer may the patient be at risk for developing in the future?

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

The nurse is assessing a patient with lung cancer. Which symptom does the nurse anticipate finding?

Dyspnea (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 are characteristics of benign tumors? Select all that apply.

Encapsulation Tight adherence Absence of migration (Benign tumors are encapsulated, which facilitates easy removal. There is a tight adherence of cells, providing a lesser chance of tumor migration. Malignant tumors invade distant organs. The increased nuclear-to-cytoplasmic ratio is a feature of malignant tumors.)

The histopathology report of a patient with breast cancer reveals poorly differentiated cells with no normal characteristics. It is also difficult to determine the tissue of origin. What is the grade of cancer the nurse anticipates will be assigned to this patient?

G4 (In the grading of malignant tumors, a G4 tumor contains cells that are poorly differentiated and have no normal cell features, and the tissue of origin is impossible to determine. A G1 tumor consists of cancer cells that are well-differentiated and have almost normal features. A G2 tumor has cells that are moderately differentiated and have some of the normal cell features. A G3 tumor consists of cells that are poorly differentiated, but the tissue of origin is easily identified.)

The nurse explains to a patient that which risk factor of those listed most likely contributed to the patient's primary liver carcinoma?

Infection with hepatitis B virus (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.)

Which statement about the process of malignant transformation is correct?

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

Which description about genetic screening is correct?

It identifies genetic risk for specific cancers. (Genetic screening helps to identify if a patient 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 patient's family; it is the patient's privilege to maintain secrecy or disclose the contents of the test to the family.)

Which type of cancer has been associated with Down syndrome?

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

A patient has been diagnosed with Bloom syndrome. Which cancer is the patient at risk for developing in the future?

Leukemia (Patients with Bloom syndrome may be at risk for developing leukemia due to a genetic predisposition. Patients with Turner's syndrome are at risk for developing meningioma. Familial clustering or Klinefelter syndrome may predispose a patient for developing breast cancer, or this cancer can be inherited. Ovarian cancer is often an inherited cancer.)

What are the features of a normal cell? Select all that apply.

Low mitotic index Tight adherence Euploidy (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.)

In 2011, what was the leading cause of cancer-related deaths in females in the U.S.?

Lung and bronchus (In the U.S., lung and bronchus cancer accounted for 26% of cancer-related deaths in females in 2011 (estimated). Breast cancer was the second-leading cause, accounting for 15%. Ovarian cancer accounted for 6%, while pancreatic cancer accounted for 7% of cancer-related deaths.)

What are the common cancers related to tobacco use? Select all that apply.

Lung cancer Cancer of the tongue Cancer of the larynx (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 are the common modes of cancer metastasis? Select all that apply.

Lymphatic Bloodborne Extension into surrounding tissues (Cancer cells may spread to distant organs through lymphatics, so primary sites that are rich in lymphatics have an early metastatic spread. Cancer may also spread through the blood by becoming dislodged from the primary site and entering the blood circulation where they may get lodged in a distant organ. A primary tumor can spread across surrounding tissues by local extension. Even though viral infection can cause cancer, they are not involved in cancer metastasis. Cancer is not contagious and does not spread by direct contact.)

What statements pertaining to cancer development are correct? Select all that apply.

Mutated normal cells may become neoplastic cells. Secondary prevention is screening for early detection. Primary prevention is preventing exposure to causes of cancer. (In cancer development, a normal cell may be transformed into a cancer cell due to the mutation of genes. Secondary cancer prevention involves performing various screening tests to detect and hinder cancer at the early stage. Primary cancer prevention entails preventing exposure to various cancer-causing substances. Tobacco may have either a permissive or causative role in cancer. Neoplastic cells can cause metastasis in distant organs.)

The nurse reviews the stages of malignant transformation of a cell. The nurse identifies that a tumor cell is in which stage if it is described as 1.5 cm in size with new branches of capillaries and exhibiting fewer normal cell features?

Progression (Malignant transformation of a cell occurs in four steps. In the progression step, continuous changes occur that makes the cell more malignant over time. This step is characterized by a tumor of size 1 cm or above with its own blood supply. As time progresses, the tumor cells at this stage have fewer and fewer normal cell features. Initiation is the first and irreversible step that leads to cancer development. This step is characterized by continuous cell changes and normal cell division. Promotion is the enhancement of growth of an initiated cell to become a cancer cell. Metastasis is the spread of cancer from one organ to another. During metastasis, cancer cells move from the primary location by breaking off from the original group and establishing remote colonies.)

Which action describes a secondary prevention measure for lung cancer?

Screening for early detection of cancer (Screening for early detection of cancer is a secondary method of preventing cancer. Regular screening for cancer does not reduce cancer incidence, but it enables early treatment which lowers the number of cancer deaths. Avoiding exposure to known causes of cancer such as tobacco smoke is a primary method of prevention of cancer. Other primary methods of prevention are modifying lifestyle behaviors and obtaining immunizations. Modifications in diet intake and alcohol consumption contribute to modification of lifestyle behaviors. Immunizations or vaccinations are useful in cases where a virus is the cause of cancer.)

To which other site does prostate cancer commonly metastasize?

Spine (Prostate cancer is known to metastasize into the bone, especially the bones of the spine, legs, and the pelvic node. Enzymes secreted by the tumor cells make large pores in the blood vessels, allowing tumor cells to enter the bloodstream. As the tumor cells are loosely held, they break off from the primary tumor and move into adjacent organs. Lung cancer is known to metastasize into the liver and pancreas. Breast cancer is known to metastasize into the lung.)

What is a known cause of skin cancer?

Tanning beds (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 risks, their exact contribution is not clear.)

Which activity performed by the community health nurse best reflects primary prevention of cancer?

Teaching a class on cancer prevention (Primary prevention involves avoiding exposure to known causes of cancer; education assists patients 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.)

How are malignant tumor cells that are graded G 1 characterized?

They closely resemble the cells from which they were produced. (In grade G1 cancer, the tumor cells closely resemble the cells from which they were produced. This indicates that the tumor is low grade, malignant, and slowly growing. In cancer graded G 2, the tumor cells are moderately differentiated; they retain some characteristic of the original cell. However, there are more malignant characteristics than G 1. Tumor cells are poorly differentiated but their origin can be established in grade G 3 cancer. These cells have few normal cell characteristics. In cancer graded G 4, tumor cells do not retain any feature of the original cell. It is difficult to determine the tissue of origin.)

When the nurse is counseling a 60-year-old African-American male patient with all of these risk factors for lung cancer, teaching should focus most on which risk factor?

Tobacco use (Although all of these are risk factors for lung cancer, the patient'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 screening guideline is recommended for the early detection of cancer?

Yearly fecal occult blood test for adults of all ages (A yearly fecal occult blood test is recommended for adults of all ages. The presence of occult blood helps to detect problems of the stomach and intestine at an earlier stage. Colonoscopy is recommended at the age of 50 and then every 10 years. Yearly mammography is recommended for patients older than 40 years. Yearly DRE and yearly prostate antigen test (PSA) is recommended for men older than 50 years. These ages have been determined through decades of research as the recommended time for screening to detect cancer early enough that treatment can reduce the incidence of death.)