Essentials Of Pathophysiology Concepts of

Altered States 4th Edition By Porth

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Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth

Chapter 6- Genetic and Congenital Disorders

1. Genetic disorders that involve a single-gene trait are characterized by:

A) Multifactorial gene mutations

B) Chromosome rearrangements

C) Mendelian patterns of transmission

D) Abnormal numbers of chromosomes

Ans: C

Feedback:

Single-gene disorders are characterized by patterns of transmission that follow the Mendelian
patterns of inheritance. Multifactorial inheritance involves more than one gene mutation,
rearrangement of groups of genes, and uneven numbers of some chromosomes in each cell.
 In one family, a son was born with polydactyly toes while his sister had polydactyly fingers. In
2. explaining this phenomenon in genetic terms to the parents, which concept should be
addressed?

A) Aneuploidy of genes in all cells

B) Deficiencies in enzyme synthesis

C) Heterozygote dominant trait

D) Variable expressivity of a gene

Ans: D

Feedback:

Autosomal dominant disorders are characterized by variable gene penetrance (degree to which
the trait is displayed) and expression (differences in how the trait is displayed). Aneuploidy is
not a single-gene disorder and does not follow the Mendelian pattern of inheritance.
Deficiencies of enzyme synthesis are common in autosomal recessive disorders. X-linked
inheritance can be dominant or recessive, but it is not autosomal.

A woman who is a carrier for which of the following diseases possesses the greatest likelihood
3.
of passing the disease to her future children when heterozygous pairing exists?

A) Phenylketonuria (PKU)

B) Tay-Sachs disease

C) Neurofibromatosis

D) Cystic fibrosis

Ans: C

Feedback:
 Neurofibromatosis is an autosomal dominant genetic disorder with a consequent 50% chance
of passing the disease to offspring. Tay-Sachs disease, PKU, and cystic fibrosis are autosomal
recessive disorders and are manifested only when both members of the gene pair are affected.

A 16-year-old male presents to the clinic complaining of headaches, trouble hearing the
teacher in the front of the classroom, and ringing in the ears. He also revealed that every time
4.
he goes swimming underwater, he gets disorientated (which never happened when he was
younger). Given these manifestations, the health care provider is going to start testing for:

A) Deafness

B) Neurofibromas

C) Tay-Sachs disease

D) Fragile X syndrome

Ans: B

Feedback:

NF-2, which is characterized by tumors of the acoustic nerve and multiple meningiomas, is
much less common than NF-1. The disorder is often asymptomatic through the first 15 years of
life. The most frequent symptoms are headaches, hearing loss, and tinnitus. Infants with Tay-
Sachs disease appear normal at birth but begin to manifest progressive weakness, muscle
flaccidity, and decreased attentiveness at approximately 6 to 10 months of age. Fragile X
syndrome, an abnormality in the X chromosome, is the common cause of inherited intellectual
disability.

5. Which of the following statements is true of autosomal recessive disorders?

A) Onset is typically late in childhood or early in adulthood.

B) Symptomatology is less uniform than with autosomal dominant disorders.

C) Mitochondrial DNA is normally the site of genetic alteration.

 D) Effects are typically the result of alterations in enzyme function.

Ans: D

Feedback:

With autosomal recessive disorders, the age of onset is frequently early in life; the
symptomatology tends to be more uniform than with autosomal dominant disorders; and the
disorders are characteristically caused by loss-of-function mutations, many of which impair or
eliminate the function of an enzyme. Mutations typically occur in nuclear, rather than
mitochondrial, DNA.

Following routine newborn testing, an infant has been diagnosed with an elevated
6. phenylalanine level. The nurse teaches the parents to follow a strict low-protein diet to
prevent which of the following major complications for the infant?

A) Kidney failure

B) Impaired brain development

C) Thyroid metabolism errors

D) Cardiac valvular disorders

Ans: B

Feedback:

Infants and children with classic and mild PKU require dietary protein restrictions to prevent
mental retardation, microcephaly, and other signs of impaired neurologic development.
Affected infants are normal at birth but within a few weeks begin to develop a rising
phenylalanine level and signs of impaired brain development. Seizures, other neurologic
abnormalities, decreased pigmentation of the hair and skin, and eczema often accompany the
mental retardation in untreated infants.

7. When a male child inherits an X-linked disorder from his heterozygous carrier mother:
 A) His sons will be carriers.

B) His father has the disorder.

C) Some of his sisters will be carriers.

D) His daughters will have the disorder.

Ans: C

Feedback:

A male who has a recessive X-linked disorder will have daughters who are carriers and sons
who are unaffected. Male children of a carrier mother have a 50% risk of having the disorder
and cannot be carriers. Female children of a carrier mother have a 50% risk of being carriers
and are not affected by the disorder.

When quizzing obstetrical nursing students regarding tissues affected by mitochondrial DNA
8.
mutations, the instructor accepts which of the following responses? Select all that apply.

A) Retinal degeneration

B) Deafness

C) Cardiac valve abnormalities

D) Absent testes

E) Palatal abnormalities

Ans: A, B

Feedback:

Mitochondrial DNA mutations generally affect tissues and organs that are highly dependent on
oxidative phosphorylation to meet their high needs for metabolic energy. Thus, mitochondrial
diseases frequently affect the brain and neuromuscular system and produce
encephalomyopathies, retinal degeneration, loss of extraocular muscle function, lactic acidosis,
and deafness.
 Which of the following statements about multifactorial inheritance disorders are accurate to
9. share with a family of a child born with a cleft lip and palate? Multifactorial inheritance
disorders: Select all that apply.

A) Can be predicted with the same degree of accuracy as Mendelian single-gene mutations

B) Usually involve more than a single organ or tissue

C) Carry the same risk for recurrence with future pregnancies

D) Have an increased risk among first-degree relatives of the affected person

E) Carry no additional risk with increasing incidence of the defect among relatives

Ans: C, D

Feedback:

Although multifactorial traits cannot be predicted with the same degree of accuracy as
Mendelian single-gene mutations, characteristic patterns exist. First, multifactorial congenital
malformations tend to involve a single organ or tissue. Second, the risk of recurrence in future
pregnancies is for the same or a similar defect. This means that parents of a child with a cleft
palate defect have an increased risk of having another child with a cleft palate. Third, the
increased risk (compared with the general population) among first-degree relatives of the
affected person is 2% to 7%. The risk increases with increasing incidence of the defect among
relatives. This means that the risk is greatly increased when a second child with the defect is
born to a couple.

The parents of a newborn infant are relieved that their baby was born healthy, with the
10. exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurse’s
following statements to the parent’s best conveys the probable cause of the infant’s cleft lip?

A) “Though you are both healthy, you likely both carry the gene for a cleft lip.”

“Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance
B)
of having one.”

C) “Your child’s cleft lip likely results from the interplay between environment and genes.”

“A cleft lip can sometimes result from taking prescription drugs, even when they’re
D)
taken as ordered.”
 Ans: C

Feedback:

A cleft lip is considered to be a multifactorial disorder, in which both environment and genes
contribute to the condition. It does not depend solely on Mendelian patterns of inheritance
and is not known to result from teratogenic drugs.

Which of the following practitioners is most likely to be of immediate assistance in the first 24
11.
hours following delivery of an infant with a cleft lip?

A) Lactation consultant

B) Respiratory therapist

C) Occupational therapist

D) Social worker

Ans: A

Feedback:

Infants with a cleft lip typically have difficulty with feeding, and the assistance of a lactation
consultant may be of help in establishing feeding patterns. Oxygenation is not a typical
problem, while activities of daily living and assistive devices are not relevant considerations.
While social work is often of assistance when a child is born with a congenital condition, a cleft
lip has fewer implications than most other inherited disorders.

The newborn has been born with distinctive physical features of trisomy 21, Down syndrome.
The mother asks the nurse, “What is wrong? My baby looks different than his brother.” The
12.
nurse assesses the infant and notes which of the following characteristics that correlate with
trisomy 21? Select all that apply.

A) Upward slanting of eyes

B) Large, protruding ears

 C) Large tongue sticking out the mouth

D) Long fingers with extra creases

E) Flat facial profile

Ans: A, C, E

Feedback:

The physical features of a child with Down syndrome are distinctive, and therefore the
condition usually is apparent at birth. These features include growth failure and a small and
rather square head. There is a flat facial profile, small nose, and somewhat depressed nasal
bridge; upward slanting of the eyes; small, low-set, and malformed ears; and a large,
protruding tongue. The child’s hands usually are short and stubby, with fingers that curl
inward, and there usually is only a single palmar crease (simian crease).

A 41-year-old woman has made the recent decision to start a family and is eager to undergo
13. testing to mitigate the possibility of having a child with Down syndrome. Which of the
following tests is most likely to provide the data the woman seeks?

A) Genetic testing of the woman

B) Genetic testing of the woman and the father

C) Prenatal blood tests

D) Ultrasonography

Ans: C

Feedback:

Down syndrome is a result of chromosomal abnormality and is not a single-gene disorder. As a

result, genetic testing of the mother and/or father is not relevant. Ultrasonography does not
have predicative value for Down syndrome, but blood tests such as a-fetoprotein, human
chorionic gonadotropin (HCG), unconjugated estriol, inhibin A, and pregnancy-associated
plasma protein A have helped ascertain the risks.
 Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The clinical
14.
manifestations of a female with monosomy X include: Select all that apply.

A) A short-stature female individual

B) Difficulty with fine motor skills

C) Large heavy breasts

D) Early-onset (age 8) puberty

E) Nonpitting lymphedema of the feet

Ans: A, B, E

Feedback:

Turner syndrome produces a female individual who is short, has no secondary sex
characteristics, has normal intelligence, and fails to go through puberty due to an absence of
ovaries. Polysomy X is a XXY male. XXY males have tall slim stature with breast enlargement,
lack of sperm, and normal intelligence. They may have problems with visuospatial organization
(driving a car, working math problems, psychomotor skills, etc.). There are variations in the
syndrome, with abnormalities ranging from essentially none to webbing of the neck with
redundant skin folds and nonpitting lymphedema of the hands and feet.

Genetic testing has revealed that a male infant has been born with an extra X chromosome.
15.
What are the most likely implications of this finding? The child:

A) Is unlikely to survive infancy

B) Is likely to have no manifestations of this chromosomal abnormality

C) Will have significant neurological and cognitive defects

D) Will be unable to reproduce

Ans: B

Feedback:

An extra X chromosome is associated with Klinefelter syndrome, but a majority of XXY males
do not exhibit visible effects of this chromosomal abnormality.
16. A teratogenic environmental agent can cause birth defects when:

A) Inherited as a recessive trait

B) Intense exposure occurs at birth

C) Disjunction occurs during meiosis

D) Exposed during early pregnancy

Ans: D

Feedback:

Teratogenic environmental agents cause birth defects when the fetus is exposed directly
during fetal development. Recessive single-gene disorders are inherited from carriers or
affected parents and are not affected by toxic agent exposures. Exposure to teratogenic agents
at birth will not cause genetic defects in that infant. Disjunction during first or second meiosis
is characteristic of aneuploidy disorders such as trisomy 21, Down syndrome, and is unrelated
to maternal environment or in utero exposures.

Which of the following variables determine the extent of teratogenic drug effects? Select all
17.
that apply.

A) Maternal health history

B) Molecular weight of the drug

C) Stage of pregnancy when the drug was taken

D) Duration of drug exposure

E) Fetal blood type

Ans: B, C, D

Feedback:
 The nature and extent of teratogenic effects are the result of numerous factors, including the
timing and molecular weight of the drug and the gestational age of the embryo or fetus. Fetal
blood type and the health history of the mother are not key variables.

18. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:

A) Directly result in liver damage

B) Extend throughout the pregnancy

C) Are most noticeable in adulthood

D) Cause death in early childhood

Ans: B

Feedback:

Unlike other teratogenic exposures that cause abnormalities during a short period of time
during fetal development (usually in the early weeks), fetal alcohol (FAS) damages the
chromosomes of the developing fetus as long as alcohol continues to circulate through the
fetal bloodstream. FAS is diagnosed by the presence of three findings that do not include liver
abnormalities and are not life threatening. Facial features characteristic of FAS are most
noticeable during childhood.

A woman who has just learned that she is pregnant for the first time has sought advice from
19. her health care provider about the safe use of alcohol during pregnancy. What advice should
the clinician provide to the woman?

A) “It’s likely best to eliminate alcohol from your diet while you’re pregnant.”

B) “Moderation in alcohol use is critical while you are pregnant.”

C) “You should limit yourself to a maximum of one drink daily while you’re pregnant.”

D) “You should drink no alcohol until you are in your second trimester.”
 Ans: A

Feedback:

Safe intake levels of alcohol during pregnancy are unknown. Even small amounts of alcohol
consumed during critical periods of fetal development may be teratogenic. As a result, it is best
for pregnant women to forego alcohol use throughout pregnancy.

A newly pregnant female is worried about her baby. She recently returned from a mission trip
to Africa. She was told there was a rubella outbreak in the next village. She has been given a
20.
TORCH screening test. If she has exposed her fetus to rubella, the nurse would expect the
infant to display which of the following possible birth defects?

A) Blindness

B) Missing limbs

C) Hydrocephalus

D) Encephalitis

Ans: A

Feedback:

The acronym TORCH stands for toxoplasmosis, other, rubella (i.e., German measles),
cytomegalovirus, and herpes, which are the agents most frequently implicated in fetal
anomalies. The TORCH screening test examines the infant’s serum for the presence of
antibodies to these agents. Although rubella has virtually been eliminated, it remains endemic
in many developing countries, where it is the major preventable cause of hearing impairment,
blindness, and adverse neurodevelopmental outcome.

21. Which of the following meals would be considered high in folic acid intake?

Deep-fried mushrooms with creamy horseradish sauce, hot dogs without bun, and
A)
potato salad
 B) Fried chicken, mashed potatoes with gravy, and corn on the cob

C) Green leafy salad, beef and bean burrito on whole-wheat shell

D) Steak, baked potato with sour cream, and cheesecake

Ans: C

Feedback:

To achieve an adequate intake of folic acid, pregnant women should couple a diet that contains
folate-rich foods (e.g., orange juice; dark, leafy green vegetables; and legumes) with sources of
synthetic folic acid, such as fortified food products.

A first-time pregnant mother asks, “Why do I need an ultrasound? I’m worried that my
22. insurance won’t cover it.” The nurse responds that an ultrasonography can diagnose prenatal
abnormalities like which of the following? Select all that apply.

A) Cytogenic abnormalities

B) Skeletal defects like facial structural problems

C) Chromosomal deficits

D) Abnormal levels of a-fetoprotein

E) Congenital heart defects

Ans: B, E

Feedback:

Ultrasonography is the primary method for assessing fetal size and screen for structural
abnormalities that include the heart, skeleton, face, diaphragm, and gastrointestinal tract.
Cytogenic studies and chromosomal analysis require amniocentesis, chorionic villus sampling,
or umbilical cord blood. a-Fetoprotein (AFP) requires a maternal blood sample that is analyzed
for serum markers associated with neural tube defects.
 A pregnant client’s a-fetoprotein (AFP) returns elevated. The couple ask the health care worker
23.
to explain what this means. Which of the following is the best response?

“This means you need to decrease your protein intake to prevent renal problems in your
A)
baby.”

“Elevated levels means your baby is at risk of having a neural tube defect like spina
B)
bifida (an opening in the spine).”

“This means your baby has Down syndrome. We won’t know how severe until after you
C)
give birth.”

“This is normal. The problem is if it is low, that means your baby will be born with
D)
trisomy 18 and will be retarded.”

Ans: B

Feedback:

Maternal and amniotic fluid levels of AFP are elevated in pregnancies where the fetus has a
neural tube defect (i.e., anencephaly and open spina bifida) or certain other malformations
such as an anterior abdominal wall defect in which the fetal integument is not intact. Screening
of maternal blood samples usually is done between weeks 16 and 18 of gestation. Although
neural tube defects have been associated with elevated levels of AFP, decreased levels have
been associated with Down syndrome.

An older mother (age 41) is worried about having a baby with birth defects. She wants to get
24. tested so she can be prepared for the outcome. Which of the following tests should the clinic
nurse prepare the client for? Select all that apply.

A) A blood test (circulating cell-free DNA) will tell if the baby is mentally retarded.

B) Abdominal x-ray can detect skeletal abnormalities.

C) Withdrawing a sample of amniotic fluid will reveal any chromosomal defects.

D) Ultrasonography will reveal any single-gene disorders like fragile X syndrome.

E) PET scanning to see if there are any areas of accelerated growth of tissue.

Ans: A, C
 Feedback:

During pregnancy, there are cf-DNA fragments from both the mother and fetus in maternal
circulation. It is possible to analyze cf-DNA from maternal blood to detect common fetal
trisomies such as Down syndrome as early as 10 weeks. Amniocentesis involves the withdrawal
of a sample of amniotic fluid from the pregnant uterus. The procedure is useful in women older
than 35 years of age, who have an increased risk of giving birth to an infant with Down
syndrome, and in parents who have another child with chromosomal abnormalities.
Ultrasonography allows the visualization of body structures, revealing such defects as skeletal
malformations. It is only able to identify chromosomal disorders, genetic disorders, and neural
tube defects by way of their anatomic effects. PET scanning is used to assess for cancer
metastasis or inflammatory diseases. It is not used in pregnancy testing.

A pregnant mother (16 weeks’ gestation) forgot and emptied her cat’s litter box without
25. gloves. She is extremely anxious and wants tested right away. Which test would the nurse
prepare her for that would give rapid cytogenic analysis?

A) Ultrasonography

B) Fetal biopsy

C) Chorionic villus sampling

D) Percutaneous umbilical cord blood sampling

Ans: D

Feedback:

Percutaneous umbilical cord blood sampling involves the transcutaneous insertion of a needle
through the uterine wall and into the umbilical artery. It is used for prenatal diagnosis of
hemoglobinopathies, coagulation disorders, metabolic and cytogenetic disorders, and
immunodeficiencies. Fetal infections such as rubella and toxoplasmosis can be detected
through measurement of immunoglobulin M antibodies or direct blood cultures. Results from
cytogenetic studies usually are available within 48 to 72 hours. Fetal biopsy is used to detect
certain genetic skin defects that cannot be diagnosed with DNA analysis. The tissue that is
obtained following sampling of the chorionic villi can be used for fetal chromosome studies,
DNA analysis, and biochemical studies. Ultrasonography makes possible the in utero diagnosis
of hydrocephalus, spina bifida, facial defects, congenital heart defects, congenital
diaphragmatic hernias, disorders of the gastrointestinal tract, and skeletal anomalies.
Cardiovascular abnormalities are the most commonly missed malformation.
Chapter 7- Neoplasia

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

“Don’t worry. We have some great cancer doctors on staff. I’m sure chemo will help you
A)
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.”

Ans: D

Feedback:

A polyp is a growth that projects from a mucosal 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.

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung
2. 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.

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.

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

A) Increasing tissue blood flow

B) Providing essential nutrients

C) Liberating enzymes and toxins

D) Forming fibrous membranes

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.

A client had a positive Pap smear. The surgeon diagnosed “cancer in situ of the cervix.” The
4. 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

Not crossed the basement membrane, so it can be surgically removed with little chance
C)
of growing back

D) Grown undifferentiated cells that no longer look like the tissue from which it arose
 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.

While studying to become chemo-certified, the nurse reviews some basic concepts about
5. 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 times 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.

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 to 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.
 While looking at cancer cells under a microscope, the instructor asks the students to describe
6.
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.

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 as 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.

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and
7.
regulated by tumor-secreted:

A) Procoagulants

B) Growth factors

C) Attachment factors

D) Proteolytic enzymes

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.

8. 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.

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
mechanisms.

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-
9.
2 level. The client/family asks, “What does this mean?” The health care provider bases his or
her response on the fact that:

The client’s immune system is trying to kill the cancer cell by sending this protein to
A)
engulf it.
 B) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any way.

This means the cancer cells have found a way to survive and grow even with damaged
C)
DNA.

The client’s body is trying to limit the blood supply to the cancer cells by producing high
D)
levels of this protein.

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.

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

A) Promotion

B) Progression

C) Initiation

D) Differentiation

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.
 Genetic screening may be indicated for individuals who have a family history of which of the
11.
following neoplasms?

A) Liver cancer

B) Multiple myeloma

C) Leukemia

D) Breast cancer

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.

A public health nurse has cited a reduction in cancer risk among the many benefits of
12. 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.

Increased cardiac workload and tissue hypoxia can interfere with normal cell
C)
differentiation.

Increased numbers of body cells increase the statistical chances of neoplastic cell
D)
changes.

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.

Which of the following dietary guidelines should a nurse provide to a group of older adults to
13.
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.”

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 amounts of complex carbohydrates may
be components of a healthy diet, but their relationship to the risk of colon cancer is not noted.

A 40-year-old female has been diagnosed with hepatocellular carcinoma. When asked what
14. 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.”

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.

A male client with a diagnosis of liver cancer has been recently admitted to a palliative care
unit following his recent development of bone metastases. His family shares with the nurse
15. 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

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.

Although clinical manifestations vary with the type of cancer and organs involved, the oncology
16. 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

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 structures. 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.

17. 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

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.
 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
18. 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

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.

A client is scheduled for a bronchoscopy related to a history of “bronchitis” for the last 3
19. 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

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.

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the
20. 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.

Tumor has metastasized to at least three distal sites and you have cancer in your lymph
B)
nodes.

C) Tumor is large and at least two lymph nodes are positive for cancer cells.

Extent of disease is unknown, but it looks like your cancer has stayed intact and not
D)
spread to the bloodstream.

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, T1, T2, T3, and T4 describe tumor
size, N0, N1, N2, and N3, lymph node involvement; and M0 or M1, the absence or presence of
metastasis.

Which of the following subjective/objective findings can be considered an adverse effect to the
21. 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

Ans: D, E

Feedback:

To some extent, radiation is 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.

A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The
22. 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

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.

A client’s oncologist has presented the possibility of implementing biotherapy in the treatment
23. 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

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.

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
24.
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

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.
 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
25.
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

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.