Unit 2:Ch 6 (Porth's 5th Ed) - Neoplasia

Question 1

Which of the following characteristics could apply to healthy somatic cells rather than cancerous cells?
A)A high rate of mutation exists in the cells.
B)The cells have a reduced tendency to cluster together.
C)They remain viable and multiply without attachments to other cells and the extracellular matrix.
D)The cells are unable to proliferate except by mitotic division.

Answer 1

Ans: D
Feedback:
Mitotic division is the normal method of division that exists in the body. High rates of mutation, reduced adhesion, and loss of anchorage dependence are associated with cancer cells.

Question 2

Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor?
A)The tumor is poorly approximated and has the potential to break loose.
B)The tumor may secrete hormones or cytokines.
C)The well-differentiated, neoplastic cells are clustered together in a single mass.
D)It has a rapid rate of growth and can induce ischemia.

Answer 2

Ans: C
Feedback:
Benign tumors are composed of well-differentiated neoplastic cells that resemble the cells of the tissues of origin and are characterized by a slow, progressive rate of growth that may come to a standstill or regress. They tend to exist in a single mass. Malignant tumors tend to be poorly differentiated, grow rapidly, secrete hormones or cytokines, and have the potential to break loose.

Question 3

A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they do not see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?
A) The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.
B) The portal circulatory system brings venous blood from the GI tract into the liver.
C) Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.
D) The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.

Answer 3

Ans: B
Feedback:
Portal circulation brings venous blood into the portal vein of the liver, facilitating hematologic spread. The parenchyma of the liver possesses no particular susceptibility to cancer, and hepatic tissue does not share traits of cancerous cells such as low contact inhibition or a lack of anchorage dependence.

Question 4

A 41-year-old female with a family history of breast cancer has had a baseline mammogram. She states that she performs monthly self-breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, “How can a lump appear so quickly?” The nurse’s
response is based on which of the following principles?
A) A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells.
B) Many tumor cells never leave the M-phase of the cell cycle.
C) Cancer cells are undifferentiated and come in various shapes and sizes.
D) If the breast has a lot of cysts, then the fluid within those sacs makes it difficult to feel the hard lumps of a cancer.

Answer 4

Ans: A
Feedback:
The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The doubling time is the length of time it takes for the total mass of cells in a tumor to double. Tumors do not stay in the M-phase of the cell cycle. Undifferentiated cancer cells do come in various shapes and sizes, but this has nothing to do with the detection of the tumor by palpation. Breast cysts are fluid-filled sacs but are usually not cancerous.

Question 5

Unbeknownst to her or her care team, a 51-year-old woman’s breast cancer has an etiology rooted in the fact that tumor-suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins, and neoplasia has resulted. What process has accounted for the woman’s cancer?
A) Chromosomal translocation
B) The “two-hit” hypothesis of carcinogenesis
C) Epigenetic mechanisms
D) A DNA repair defect

Answer 5

Ans: C
Feedback:
Epigenetic mechanisms may silence genes, such as tumor suppressor genes, so that even though the gene is present, it is not expressed and a cancer-suppressing protein is not made. This process does not involve defects in DNA repair or chromosomal translocation, and while it may form a half of the “two-hit” hypothesis, this is not synonymous with epigenetic mechanisms.

Question 6

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

Answer 6

Ans: D
Feedback:
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 for cancer.

Question 7

Blood-borne cancerous cells have recently spread from a woman's primary tumor in her pancreas to her bones. Which of the following components of the woman's immune system are likely to be directly involved in the attempt to eradicate the potential metastasis? Select all that apply.
A) T lymphocytes
B) Macrophages
C) Natural killer (NK) cells
D) B cells
E) Mast cells

Answer 7

Ans: A, B, C, D Feedback:
Virtually all of the components of the immune system have the potential for eradicating cancer cells, including T lymphocytes, B lymphocytes, antibodies, macrophages, and natural killer (NK) cells. Although best known for their role in allergy and anaphylaxis, mast cells play an important protective role as well, being intimately involved in wound healing and defense against pathogens.

Question 8

A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her family physician during an office visit. How can the physician best respond to the woman’s query?
A) “Though it’s not particularly common, it’s true that certain bacteria and viruses can lead to cancer.”
B) “Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses.”
C) “There are many viruses, but only a very few of them have been shown to cause cancer in humans.”
D) “This is true; for example, HIV has been shown to cause cancer in some patients.

Answer 8

Ans: C
Feedback:
Four DNA viruses have been implicated in human cancers: the human papillomavirus (HPV), Epstein-Barr virus (EBV), hepatitis B virus (HBV), and human herpesvirus-8 (HHV-8). Bacteria have not been linked with cancer, and viruses do not account for a large proportion of cancer cases. HIV is associated with an increased risk of cancer caused by HHV-8, but HIV itself does not cause cancer.

Question 9

The family of a 68-year-old man who is in the end stages of small cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the client’s anorexia and cachexia?
A) Inadequate cellular metabolism of glucose results from tumor factors.
B) High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting.
C) Products of the tumor itself as well as a hypermetabolic state cause cachexia.
D) Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat.

Answer 9

Ans: C
Feedback:
The mechanisms of anorexia–cachexia in cancer patients are multifactorial, involving factors that include a hypermetabolic state and the production of specific cytokines and catabolic factors by the tumor. Glucose metabolism itself is not noted to be affected by tumors, and muscle mass is lost in large amounts. The phenomenon is not necessarily attributable to the decrease in food intake.

Question 10

The nurse caring for a lung cancer patient with metastasis to the brain suspects the patient has developed a paraneoplastic syndrome known as syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which laboratory result in this patient who has gained 3 lb in a day would alert the nurse to the possibility of SIADH?
A) Serum potassium of 5.0 mmol/L
B) Serum sodium of 115 mmol
C) BUN of 8 mg/dL
D) Hematocrit of 40%

Answer 10

Ans: B
Feedback:
SIADH is the principal cause of hyponatremia in malignant disease. It may be caused by oat cell carcinoma of the lung and certain other malignant tumors or be due to the tumor producing vasopressin. The other lab values, K+, BUN, and hematocrit are all within normal adult ranges

Question 11

A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers?
A) “Tumor markers are a very useful screening tool, but they only exist for a very few types of cancer.”
B) “Tests for the presence of tumor markers are limited by the fact that they are only accurate in the very early stages of cancer.”
C) “Tumor markers are an excellent screening tool, but it’s only practical to test for those cancers that you’re at risk of.”
D) “Tumor markers alone aren’t enough to confirm whether you have cancer or not, so they’re not a very useful screening tool.”

Answer 11

Ans: D
Feedback:
As diagnostic tools, tumor markers have limitations. Nearly all markers can be elevated in benign conditions, and most are not elevated in the early stages of malignancy.
Hence, tumor markers have limited value as screening tests. Furthermore, they are not in themselves specific enough to permit a diagnosis of a malignancy.

Question 12

A 51-year-old female has been found to have a metastatic lesion in her lung, and her oncologist is unsure of the site of the primary tumor. Which of the following procedures is most likely to aid in this determination?
A) Immunohistochemistry
B) Tumor markers
C) Microarray technology
D) Tissue biopsy

Answer 12

Ans: A
Feedback:
Immunohistochemistry can be used to determine the site of origin of metastatic tumors. In cases in which the origin of the metastasis is obscure, immunochemical detection of tissue-specific or organ-specific antigens can often help to identify the tumor source.
Tumor markers, microarray technology, and biopsy are less likely to aid in identifying the primary source.

Question 13

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

Answer 13

Ans: D
Feedback:
Chemotherapy and radiation treatment both preferentially affect rapidly proliferating cells that include some normal body cells, such as epithelial and hair follicle cells, as well as cancer cells.

Question 14

Upon entering the room of a 74-year-old client receiving brachytherapy for cervical cancer, you find the radiation implant and the position-holding device in the client’s bed. What is the nurse’s first best action?
A) Assess the client’s mental status.
B) Use tongs to place the implant in the radiation container.
C) Notify the physician and move the client to a different room.
D) Don gloves and attempt to reposition the implant and positioning device.

Answer 14

Ans: B
Feedback:
To minimize staff radiation exposure, the rules of time, distance, and shielding come into play. If a radioactive device dislodges, there should be a lead container and tongs in the room, so the device can be safely stored until the radiology department can dispose of of it safely.

Question 15

A cancer patient has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the
S-phase of the cell cycle. When teaching this patient, the nurse explains that during the S-phase of the cell cycle,
A) the cell is in a prolonged resting state and only leaves this state when cellular destruction is occurring.
B) the DNA synthesis stops, but RNA synthesis continues.
C) nuclear division occurs.
D) the synthesis of DNA occurs, causing two separate sets of chromosomes to develop.

Answer 15

Ans: D
Feedback:
During the S-phase, DNA synthesis occurs, causing two separate sets of chromosomes to develop. Antimetabolites can cause abnormal timing of DNA synthesis. Because of their S-phase specificity, the antimetabolites are more effective when given as a prolonged infusion.

Question 16

A 61-year-old male client is scheduled to begin chemotherapy for the treatment of his bone cancer shortly. Staff at the cancer center have educated the man and his wife about the goals, course, and expectations of his treatment. Which of the following medications and treatments might the man anticipate needing during and after his course of treatment?
A) Analgesia and corticosteroids
B) Antiemetics and packed red blood cell (PRBC) transfusions
C) Whole blood transfusion and antiplatelet aggregators
D) Diuretics and selective serotonin reuptake inhibitors (SSRIs)

Answer 16

Ans: B
Feedback:
Nausea and anemia are common side effects of chemotherapy and may be addressed with antiemetics and PRBCs. There is no noted indication with chemotherapy for corticosteroids, antiplatelet aggregators, diuretics, or SSRIs.

Question 17

A patient with malignant melanoma has been prescribed alpha interferon, a biologic response modifier. Since this drug prolongs the cell cycle, increasing the percentage of cells in the G0 phase, and stimulates NK cells and T-lymphocyte killer cells, the nurse can anticipate that he may experience which of the following common side effects?
A) Fever, chills, and fatigue
B) Nausea, vomiting, and diarrhea
C) Opportunistic infections like Candida
D) Renal damage with an increased creatinine level

Answer 17

Ans: A
Feedback:
Interferon is a biologic response modifier that changes a person’s own immune response to cancer. This medication is given by injection, usually every other day. Because of stimulation of the body’s natural immune response, the patient experiences extreme flulike symptoms.

Question 18

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?
A) There will be a greater number of cancers that are epithelial in origin.
B) A greater proportion of the clients will have cancer that involves the hematopoietic system.
C) The nurse will be working with more clients who have blastomas.
D) More clients will be receiving treatment for leukemia.

Answer 18

Ans: A
Feedback:
Epithelial cancers are more common in adults, while “blastomas” and cancers of the hematopoietic system such as leukemia are more common in children

Question 19

A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?
A) Recurrence of ALL
B) CNS problems resulting from childhood chemotherapy
C) Heart failure resulting from childhood chemotherapy
D) Hormonal dysfunction resulting from childhood chemotherapy

Answer 19

Ans: C
Feedback:
The patient’s symptoms resemble those of congestive heart failure. The anthracyclines, such as doxorubicin and daunorubicin, are associated with the risk for developing cardiomyopathy and heart failure.

Question 20

The mother of an 18-month-old child is concerned that her child is lethargic and is not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which of the following clinical manifestations would lead the health care provider to suspect the child may have a neuroblastoma? Select all that apply.
A) Large protruding abdomen
B) Excessive burping
C) Weight loss
D) Large amount of pale urine
E) Crying when position is changed

Answer 20

Ans: A, C, E
Feedback:
Neuroblastomas are the second most common solid malignancy in childhood after brain tumors. Clinical manifestations vary with the primary site (usually the adrenal glands) and include large abdominal masses, fever, and possibly weight loss. Bone pain suggests metastatic disease.

Question 21

Following routine colonoscopy screening, a client is told that he had several polyps
removed. The client began crying stating, “I just can’t deal with cancer. I’m too young.”
The nurse responds:

A) “Don’t worry. We have some great cancer doctors on staff. I’m sure chemo will
help you fight it.”
B) “Maybe if you’re lucky, they have stopped it from metastasizing to your liver.”
C) “A simple intestinal surgery will cure you.”
D) “Most colon polyps are not cancerous. The biopsy results will direct your care. ‘

Answer 21

Ans: D
Feedback:
A polyp is a growth that projects from a mucosa! surface, such as ,the intestine. Although
the term usually implies a benign neoplasm, some malignant tumors also appear as
polyps. Adenomatous polyps are considered precursors to adenocarcinomas of the
colon.

Question 22

A lung biopsy and magnetic resonance imaging have confirmed the presence of a
benign lung tumor in a client. Which of the following characteristics is associated with
this client’s neoplasm?

A) The tumor will grow by expansion and is likely encapsulated.
B) The cells that constitute the tumor are undifferentiated, with atypical structure.
C) If left untreated, the client’s tumor is likely to metastasize.
D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.

Answer 22

Ans A
Feedback:
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.

Question 23

A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast
without displaying many signs/symptoms. The nurse responds that malignant tumor
affect area tissues by:

A) Increasing tissue blood flow
B) Providing essential nutrients
C) Liberating enzymes and toxins
D) Forming fibrous membranes

Answer 23

Ans: C
Feedback:
Malignant tumors affect area tissues by liberating enzymes and toxins that destroy
tumor tissue and normal tissue. In addition, the malignant cells compress area vessels,
causing ischemia and tissue necrosis. The high metabolic rate of tumor growth causes
the tumor to deprive the normal tissues of essential nutrients.

Question 24

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:

A) Been walled off within a strong fibrous capsule
B) Developed a distant infiltration
C) Not crossed the basement membrane, so it can be surgically removed with little
chance of growing back . “
D) Grown undifferentiated cells that no longer look like the tissue from which it
arose

Answer 24

Ans: C
Feedback:
Cancer in situ is a localized preinvasive lesion. As an example, in 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.

Question 25

While studying to become chemo-certified, the nurse reviews some basic concepts about
cancer cells. When a client asks about why the tumor grows so fast, the nurse will
respond based on which of the following physiological principles? Select all that apply.

A) Cancer cells have shorter cell cycle time than normal cells.
B) Cancer cells do not die when they are programmed to die.
C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase.
D) Cancer cells will reach a balance between cell birth and cell death rate.
E) Cancer cells never reach a flattened growth rate.

Answer 25

Ans: B,C
Feedback:
One of the reasons cancerous tumors often seem to grow so rapidly relates to the size of
the cell pool that is actively engaged in cycling. It has been shown that the cell cycle
time of cancerous tissue cells is not necessarily shorter than that of normal cells. Rather,
cancer cells do not die on schedule, and growth factors prevent cells from exiting the
cell cycle and entering the G0 or noncycling phase. The ratio of dividing cells to resting
cells in a tissue mass is called the growth fraction. The doubling time is the length of
time it takes for the total mass of cells in a tumor to double. As the growth fraction
increases, the doubling time decreases. When normal tissues reach their adult size, an
equilibrium between cell birth and cell death is reached. Cancer cells, however, continue
divide until limitations in blood supply and nutrients inhibit their growth. When this
occurs, the doubling time for cancer cells decreases. The initial growth rate is
exponential and then tends to decrease or flatten out over time.

Question 26

While looking at cancer cells under a microscope, the instructor asks the students to
describe the cells. Which of the student answers are accurate? Select all that apply.

A) The cells are in different sizes and shapes.
B) The nucleoli are larger than normal.
C) The cells are contact inhibited.
D) The cells do not resemble the tissue of origin.
E) The cells are attached to an extracellular matrix.

Answer 26

Ans: A.,B, D
Feedback:
Undifferentiated cancer cells are marked by a number of morphologic changes. Both the
cells and nuclei display variations in size and shape. Their nuclei are variable in size and
bizarre in shape, their chromatin is coarse and clumped, and their nucleoli are often
considerably larger than normal. The cells of malignant tumors are characterized by
wide changes of parenchymal cell differentiation from well differentiated to completely
undifferentiated. Normal cells that are grown in culture tend to display a feature called
cell density-dependent inhibition, in which they stop dividing after the cell population
reaches a particular density. This is sometimes referred to ~ contact inhibition since
cells often stop growing when they come into contact with each other. In contrast to
normal cells, cancer cells often survive in microenvironments different from those of the
normal cells. They frequently remain viable and multiply without normal attachments to
other cells and the extracellular matrix.

Question 27

The angiogenesis process, which allows tumors to develop new blood vessels, is
triggered and regulated by tumor-secreted:

A) Procoagulants
B) Growth factors
C) Attachment factors
D) Proteolytic enzymes

Answer 27

Ans: B
Feedback:
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.

Question 28

Which of the following processes characterizes an epigenetic contribution to
oncogenesis?

A) A DNA repair mechanism is disrupted
B) A tumor suppressor gene is present, but it is not expressed.
C) Cells lose their normal contact inhibition.
D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

Answer 28

Ans: B
Feedback:
Epigenetic mechanisms of cancer growth involve changes in .the patterns of gene
expression without a change in the DNA. Epigenetic mechanisms may “silence” genes,
such as tumor suppressor genes, so that even though the gene is present, it is not
expressed and a cancer-suppressing protein is not made. Disruption of DNA repair may
contribute to cancer, but this process is not particular to epigenetics. Similarly, loss of
contact inhibition and impaired apoptosis are associated with cancer but are not specific
manifestations of epigenetic mechanism.

Question 29

An oncology nurse is caring for a client with newly diagnosed B-cell lymphoma.
Extensive blood work has been drawn and sent to the lab. Results reveal an elevated
antiapoptotic protein BCL-2 level. The client/family ask, “What does this mean?” The
health care provider bases his or her response on the fact that:

A) The client’s immune system is trying to kill the cancer cell by sending this protein
to engulf it.
B) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any
way.
C) This means the cancer cells have found a way to survive and grow even with
damaged DNA.
D) The client’s body is trying to limit the blood supply to the cancer cells by
producing high levels of this protein

Answer 29

Ans: C
Feedback:
Alterations in apoptotic and antiapoptotic pathways have been found in many cancers.
One example is the high levels of the antiapoptotic protein BCL-2 that occur secondary
to a chromosomal translocation in certain B-cell lymphomas. The mitochondrial
membrane is a key regulator of the balance between cell death and survival. Proteins in
the BCL-2 family reside in the inner mitochondrial membrane and are either
proapoptotic or antiapoptotic. Since 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.

Question 30

A farmer’s long-term exposure to pesticides has made the cells in his alveoli and
bronchial tree susceptible to malignancy. Which of the following processes has taken
place in the farmer’s lungs?

A) Promotion
B) Progression
C) Initiation
D) Differentiation

Answer 30

Ans: C
Feedback:
Initiation involves the exposure of cells to appropriate doses of a carcinogenic agent that
makes them susceptible to malignant transformation, whereas promotion involves the
induction of unregulated accelerated growth in already initiated cells. Progression is the
later process whereby tumor cells acquire malignant phenotypic changes, and
differentiation is the process of specialization whereby new cells acquire the structural,
microscopic, and functional characteristics of the cells they replace.

Question 31

Genetic screening may be indicated for individual, who have a family history of which
of the following neoplasm?

A) Liver cancer
B) Multiple myeloma
C) Leukemia
D) Breast cancer

Answer 31

Ans: D
Feedback:
The hereditary component of cancer is well identified, although it is implicated in
varying degrees in different types of cancer. Breast cancer has an identified genetic
component, and screening is often recommended for women with a family history of
breast cancer.

Question 32

A public health nurse has cited a reduction in cancer risk among the many benefits of
maintaining a healthy body mass index. Which of the following facts underlies the
relationship between obesity and cancer?

A) Obesity can cause inflammation and hormonal changes that are associated with
cancer.
B) Adipose tissue is more susceptible to malignancy than other types of connective
tissue.
C) Increased cardiac workload and tissue hypoxia can interfere with normal cell
differentiation.
D) Increased numbers of body cells increase the statistical chances of neoplastic cell
changes.

Answer 32

Ans: A
Feedback:
Obesity has a complex interplay with the development of cancer that is thought to result
from the influence of hormonal changes and inflammation. It is not thought to be due to
the increased number of cells in the body or to any particular susceptibility of adipose
tissue. Increased cardiac workload and hypoxia are not known to cause neoplastic
changes.

Question 33

Which of the following dietary guidelines should a nurse provide to a group of older
adults to possibly decrease their risks of developing colon cancer?

A) “As much as possible, try to eat organic foods.”
B) “Regular vitamin supplements and a low carbohydrate diet are beneficial.”
C) “Try to minimize fat and maximize fiber when you’re planning your meals.”
D) “Eat enough fiber in your diet that you have bowel movement at least once daily.”

Answer 33

Ans: C
Feedback:
A low-fat, high-fiber diet is thought to provide some protection from colon cancer.
Organic foods, vitamin supplements, and avoidance of large amount of complex
carbohydrates max be components of a healthy diet, but their relationship to the risk of
colon cancer is not noted.

Question 34

A 40-year-old female has been diagnosed with hepatocellular carcinoma. When asked
what causes this cancer, the physician looks at the history and responds, “I see in your
history, you have had:

A) Hepatitis B related to IV drug use as a teenager.”
B) Numerous admissions for COPD exacerbations requiring steroids.”
C) Three miscarriages with no live births.”
D) Your uterus and ovaries removed for endometriosis.”

Answer 34

Ans: A
Feedback:
There is strong epidemiologic evidence linking chronic HBV and hepatitis C virus
(HCV) infection with hepatocellular carcinoma. It has been estimated that 70% to 85%
Of hepatocellular cancers worldwide are due to infection with HBV or HCV. COPD,
steroidal use, miscarriages, or ·endometriosis is not associated as a risk factor for
hepatocellular carcinoma.

Question 35

A male client with a diagnosis of liver cancer has been recently admitted to a palliative
care unit following his recent development of bone metastasis. His family shares with
the nurse that even though he is usually a “big eater” he just isn’t interested in food.
This has resulted in a loss of muscle mass. Which of the following factors may underlie
the client’s change in nutritional status?

A) The action of cytokines and persistent inflammation
B) Loss of appetite due to fatigue and pain
C) changes in peptide hormone levels
D) Production of onconeural antigens by cancerous cells

Answer 35

Ans: A
Feedback:
Cancer anorexia-cachexia syndrome is thought to result from a persistent inflammatory
response in conjunction with production of specific cytokines and catabolic factors by
the tumor. The weight loss often supersedes the effects of fatigue and reduced food
intake. The production of onconeural antigens and changes in peptide hormone levels
occur in some clients with cancer, but these pathophysiologic processes do not
contribute directly to cancer anorexia-cachexia syndrome.

Question 36

Although clinical manifestations vary with the type of cancer and organs involved, the
oncology nurses have observed that the most frequent side effects clients with cancer
experience are: Select all that apply.

A) Copious lymph flow
B) Sleep disturbances
C) Involuntary weight gain
D) Visceral organ expansion ~
E) Lack of energy

Answer 36

Ans: B,E
Feedback:
Neoplasia is nearly always accompanied by sleep disturbances and fatigue.
Cancer-related fatigue 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. Tissue growth often compresses and obstructs
lymph flow and compresses visceral organs and adjacent structure . The cachexia of
cancer is associated with unplanned rapid weight loss and wasting of body fat as tumor
growth demands more caloric energy than the body can supply.

Question 37

Paraneoplastic syndromes are manifestations of cancer that often result from:

A) Radiation and chemotherapy
B) Compression of area vessels
C) Tumor-related tissue necrosis
D) Inappropriate hormone release

Answer 37

Ans: D
Feedback:
Paraneoplastic syndromes are manifestations in sites that are not directly affected by the
disease; many are caused by excessive or inappropriate peptide hormone synthesis and
release by cancer cells. Radiation and chemotherapy are cancer treatments that cause
side effects unrelated to the paraneoplastic syndromes. Area vessel compression is a
direct result of the tumor’s location; area tissue necrosis is a direct result of area tissue
destruction and death of healthy cells.

Question 38

A client with nonspecific signs/symptoms has gone to the primary health care provider.
The client’s chief complaints revolve around extreme fatigue, unplanned weight loss,
and being so weak in the muscles. The diagnostic workup included a carcinoembryonic
antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate
the physician will order which of the following diagnostic tests related to the elevated
CEA? Select all that apply.

A) Testicular ultrasound
B) Colonoscopy
C) Mammogram
D) Thyroid scan
E) Brain CT

Answer 38

Ans: B,C
Feedback:
CEA normally is produced by embryonic tissue in the gut, pancreas, and liver and is
elaborated by a number of different cancers, including colorectal carcinomas, pancreatic
cancers, and gastric and breast tumors.

Question 39

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 the problem by:

A) Visualizing airways looking for adhesions
B) Opening airways looking for any aspirated food
C) Flushing out the airway to remove debris and sputum
D) Taking tissue biopsy and looking for abnormal cells

Answer 39

Ans: D
Feedback:
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

Question 40

A breast cancer client has just learned that her tumor clinical stage is T1, N2, MO. After
the physician leaves, the client asks the nurse to explain this to her again. The nurse will
use which of the following statements in his or her answer? Your:

A) Tumor is very small and has zero number of mitoses.
B) Tumor has metastasized to at least three distal sites and you have cancer in your
lymph nodes.
C) Tumor is large and at least two lymph nodes are positive for cancer cells.
D) Extent of disease is unknown, but it looks like your cancer has stayed intact and
not spread to the bloodstream.

Answer 40

Ans: C
Feedback:
Tumor staging groups clients according to the extent and spread of the disease, using -the
TNM (tumor, node, and metastasis) system. In the TNM system, Tl, T2, T3 and T4
describe tumor size, NO, NI, N2, and N3, lymph node involvement; and MO or M1, the
absence or presence of metastasis.

Question 41

Which of the following subjective/objective 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.

A) Urine output less than 30 mL/hr (low)
B) Increase production of nasal secretions
C) Stiff, painful joints in the AM
D) Hemoglobin 9.0 g/dL (low)
E) Complains of frequent nausea and vomiting

Answer 41

Ans: D,E
Feedback:
To some extent, radiation injurious to all rapidly proliferating cells, including those of
the bone marrow and the mucosal lining of the gastrointestinal tract. This results in
many of the common adverse effects of radiation therapy, including infection, bleeding,
and anemia due to loss of blood cells and nausea and vomiting due to loss of
gastrointestinal cells.

Question 42

A 51-year-old client has been diagnosed with stage IV breast cancer with lung
metastases. The oncologist sits down with the client/family to explain treatment options.
The nurse knows that which of the following treatment options will be discussed for her
cancers?
A) Radiation therapy
B) Chemotherapy
C) Surgery
D) Hormone therapy

Answer 42

Ans: B
Feedback:
One of the advantages of chemotherapy is that, unlike surgery and radiation, it is able to
treat cancer both at the primary site and at sites of metastasis. Hormone therapy is also
able to exert therapeutic effects at a more systemic level, but to a lesser degree than
chemotherapy.

Question 43

A client’s oncologist has presented the possibility of implementing biotherapy in the
treatment of the client’s brain tumor. Which of the following-mechanisms of action
provide the therapeutic effects of biotherapy? Select all that apply.

A) Stimulating the immune response to tumor cells
B) Inhibiting tumor protein synthesis
C) Reversing angiogenesis
D) Altering the hormonal environment of tumor cells
E) Causing breaks in the DNA of tumor cells

Answer 43

Ans: A, B
Feedback:
Biotherapy exerts therapeutic effects by way of altering host responses (such as by
stimulating the immune response) or by inhibiting tumor cell biology (e.g., inhibiting
protein synthesis). Biotherapy does not reverse existing angiogenesis, and the hormonal
environment is not a particular focus of biotherapy. Radiation is the primary means by
which breaks in tumor DNA are made.

Question 44

A 2-year-old child has been diagnosed with neuroblastoma. The tumor is extremely
large. Parents ask how this cancer could be so extensive, yet the child has not displayed
many symptoms until this past week. Nurses explain that early diagnosis of childhood
cancers is often difficult because the signs and symptoms are:

A) Already present at birth
B) Absent until the late stage
C) Similar to those of other childhood diseases
D) Seen as developmental delays

Answer 44

Ans C
Feedback:
Early diagnosis is missed in childhood cancers because the signs and symptoms are
similar to those of other childhood diseases. Multiple chromosomal mutations can cause
some of the early childhood cancers, with signs and symptoms similar to other
childhood diseases. Signs and symptoms are present even in the early stages of cancer.
Childhood growth delays (rather than developmental delays) are associated with cancers
and other diseases.

Question 45

A 5-year-old girl’s diagnosis of bone cancer required an aggressive treatment regimen.
The client immediately receives doxorubicin chemotherapy. The nurse administering
this medication should perform a detailed assessment of which body system that has
been greatly affected by this drug?

A) CNS
B) Renal
C) Cardiac
D) Respiratory

Answer 45

Ans: C
Feedback:
There are numerous, multisystemic sequelae of chemotherapy and radiation that are
required in childhood. Vital organs such as the heart and lungs may be affected by
cancer treatment. Children who received anthracyclines (i.e., doxorubicin or
daunorubicin) may be at risk for developing cardiomyopathy and congestive heart
failure.