Patho chapter 6-8-9-10 – Flashcards
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A client has cancer. While planning care, the nurse recalls that which type of immunity attacks cancer?
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Cellular, or cell-mediated, immunity targets viruses and cells that have become cancerous. Humoral immunity provides protection against many bacteria and viruses. Mucosal immunity is the secretory immune system and provides protection from infectious microorganisms in secretions. Visceral is not a type of immunity.
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A nurse is talking about a very small antigen that must combine with larger molecules to produce an immune response in a client. What is the nurse describing?
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Many low-molecular-weight molecules can function as haptens, antigens that are too small to be immunogens by themselves but become immunogenic after combining with larger molecules that function as carriers for the hapten. Antibodies form against antigens. Immunoglobulin is another name for antibody. Additionally, both immune systems (humoral and cellular) produce specialized subpopulations of memory cells, which are capable of remembering the specific antigen and responding more rapidly and efficiently against future infections.
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A nurse must explain the differences between the innate immune response and the adaptive immune response. Which information should the nurse include to highlight the differences?
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The adaptive immune response is antigen-specific. The innate immune response is the same regardless of the antigen and therefore is not antigen-specific. The adaptive immune response generally takes longer to develop than an innate immune response. Both innate and adaptive immune responses can react to microorganisms. Adaptive immune cells have the capacity to develop memory of a specific antigen. Innate immunity does not develop memory cells.
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Which term should the nurse use to describe the function of an antibody that inactivates or blocks the binding of an antigen to a client's host cell receptor?
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Neutralization is inactivating or blocking the binding of antigens to receptors. Phagocytosis is a function of macrophages and neutrophils that involves ingestion and disposal of antigens. Antigen processing is carried out by phagocytic cells that break up and present particles of antigens to lymphocytes as part of the adaptive immune response. Agglutination is the clumping of insoluble particles that are in suspension.
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A client has an inappropriate, exaggerated response against a noninfectious environmental substance. Which term should the nurse use when reporting this condition to another healthcare professional?
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Inappropriate responses (hypersensitivity reactions) may be (1) exaggerated against noninfectious environmental substances (allergy); (2) misdirected against the body's own cells (autoimmunity); or (3) directed against beneficial foreign tissues, such as transfusions or transplants (alloimmunity). Acute rejection is a cell-mediated immune response that occurs within days to months after transplantation.
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The parents of an infant with which condition will need the most complex teaching about protecting their infant from infection?
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Individuals who have SCIDs have defective cell-mediated and humoral immunity, the most severe immunodeficiency. Individuals who have DiGeorge syndrome have defective cell-mediated immunity; antibody production may be diminished, but antibody response is normal. Individuals who have selective IgA deficiency have partially defective humoral-mediated immunity, but cell-mediated immunity is not impaired. Individuals who have Bruton agammaglobulinemia have defective humoral-mediated immunity, but cell-mediated immunity functions normally.
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he client in early-stage HIV infection will exhibit which clinical manifestations upon assessment?
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Those with the early stages of HIV disease (early-stage disease) usually initially present with relatively mild and nonspecific symptoms resembling influenza, such as headaches, fever, or fatigue. Early-stage HIV infection does not include gastroenteritis. Multiple opportunistic infections, diarrhea, weight loss, and severe lymphadenopathy are manifestations of AIDS.
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The nurse is monitoring four patients who require blood transfusions. Which patient will receive safe and effective treatment?
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Blood group O is a universal donor, as it contains neither A nor B antigens. Therefore, Patient A with A positive blood group will receive safe and effective treatment. Patients with AB negative blood group do not contain Rh antigens. Therefore, Patient B has a risk of hemolytic reaction due to transfusion of AB positive blood. B positive blood contains anti-A antibodies that will react with antigen A present in AB blood group. Therefore, Patient C has risk of hemolytic reaction. Patient with O positive can only receive blood from individuals having O positive blood type. Therefore, transfusing B positive blood can cause hemolytic reaction in Patient D.
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Which action by the new nurse would cause the charge nurse to intervene?
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Although people with type O blood are the universal donors, people with type O can only receive blood from another person with type O. Giving them type AB blood would cause a transfusion reaction, producing agglutination. People with type AB are the universal recipients and can receive blood from any type. Type A can only receive from types A and O. Type B can only receive from types O and B.
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A nurse is discussing HAART with the oncoming nurse for the next shift. What is the nurse describing?
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HAART is highly active antiretroviral therapy for AIDS. It is not for symptoms of heart disease, histamine deficiency, or excessive immune responses.
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A client had a reaction to a liver transplant. Which term will the nurse use to describe this event?
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Alloimmunity can be observed during immunologic reactions against transfusions, transplanted tissue, or a fetus (during pregnancy). Allergic reactions are a hypersensitivity response to environmental antigens. Autoimmune diseases occur when the immune system reacts against self-antigens and causes damage. Anaphylaxis involves severe bronchoconstriction and hypotension, which can be life-threatening. It results not from transplants but from allergens.
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"My doctor said I have an autoimmune disease. What does that mean?" asks a client. How should the nurse respond?
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Autoimmunity is a breakdown in the ability of the immune system to differentiate self-antigens from nonself-antigens. The immune cells react destructively to the person's cells as if they were foreign antigens. Inability to create antibodies and destruction of immune cells by an infecting microorganism are examples of immunodeficiencies. Urticaria (hives) can occur with autoimmunity, but urticaria as an allergic response to something in the environment is not autoimmunity.
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A child who has a congenital immunodeficiency that impairs B lymphocyte function will have primarily a deficiency of which immune component?
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B lymphocyte deficiencies cause defects in antibody production, because B lymphocytes are the antibody-producing cells. Several types of immune cells can produce cytokines. B lymphocytes do not produce complement proteins or cytotoxic T cells (Tc cells).
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A client with a B-cell deficiency is receiving gamma globulin. When the client asks about the drug therapy, how should the nurse respond?
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Administration of gamma globulin temporarily replaces the antibodies that are lacking because of the B-cell deficiency. Antibodies from these preparations are removed slowly from the blood, with half of the antibodies being removed by 3 to 4 weeks. Thus individuals must be treated repeatedly to maintain a protective level of antibodies in the blood. More than one treatment is required; 12 hours and 7 days are not accurate treatment times for B-cell deficiency.
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A nurse hears in an interdisciplinary meeting that a client has cancer-causing mutations to proto-oncogenes. How should the nurse interpret this finding? Correct 2 The client will have increased cell growth and division
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Proto-oncogenes promote normal cell division, and cancer-causing mutations allow proto-oncogenes to transform into oncogenes, leading to an increased rate of cell proliferation and growth. Apoptosis leads to cellular destruction. Monoclonal antibodies produced in a laboratory environment are used to treat certain cancers and autoimmune conditions. Decreased cell responsiveness to growth factors would not contribute to the excessive cell proliferation characteristic of cancer; in fact the opposite would occur (decreased cell growth).
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A nurse is teaching the staff about genes that normally inhibit cellular proliferation in the normal state of the cell. Which type of gene is the nurse describing? Correct 4 Tumor-suppressor genes
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Tumor-suppressor genes encode proteins that in their normal state negatively regulate (halt, or "put the brakes on") proliferation. Hence, they also have been referred to as anti-oncogenes. Oncogenes in their normal nonmutant state direct the synthesis of protein that positively accelerates proliferation; in the setting of viral-induced mutation they can contribute to malignancy. A proto-oncogene is an oncogene in its nonmutant state. Telomeres are protective ends or caps on each chromosome.
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A cancer cell reactivates the gene for telomerase. What action does the nurse expect to happen in the client's cells? Correct 2 Unlimited replication
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The gene for telomerase is deactivated in normal differentiated cells. Reactivation of the gene for telomerase creates the capacity for unlimited replication. Cancer cells evade apoptosis by causing a mutation in the p53 tumor-suppressor gene, not by activating telomerase. Cancer cells lose contact inhibition by inactivation of the tumor-suppressor gene retinoblastoma or, conversely, activation of the protein kinases that drive the cell cycle, the cyclin-dependent kinases. Anchorage independence does not relate to telomerase.
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Which assessment findings are characteristic of a client with cachexia? Select all that apply.
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Cachexia, an important clinical manifestation of cancer, includes anorexia, early satiety, weight loss (not weight gain), anemia, asthenia, taste alterations, and altered metabolism. Anorexia leads to decreased appetite, not increased.
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A client with cancer develops thrombocytopenia from chemotherapy. Which complication should the nurse monitor for in this client? Hemorrhage
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Thrombocytopenia is a major cause of hemorrhage in persons with cancer and is often treated with platelet transfusions. Anemia is from a lack of red blood cells, not a lack of platelets. Infection risk increases from a lack of white blood cells, not a lack of platelets. Granulocytopenia is a lack of a certain type of white blood cell.
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A client has a benign new cellular growth. Which term will the nurse use in report to describe this condition? Neoplasms
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The word tumor originally referred to any swelling that was caused by inflammation, but it is now generally reserved for describing a new growth, or neoplasm. Not all tumors or neoplasms, however, are cancer. The term cancer refers to a malignant tumor and is not used to refer to benign growths such as lipomas or hypertrophy of an organ. Apoptosis is programmed cell death.
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A client with a malignant tumor says, "The doctor said my tumor is growing really quickly. Why does it grow so fast?" Which principle is the basis for the response that a nurse should provide?
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Lack of contact inhibition enables excessive cell replication and malignant transformation. Cancer cells are often called immortal because they seem to have an unlimited life span. Apoptosis is a form of programmed cell death, not growth. Malignant cells encourage angiogenesis, one of the ways tumor growth is facilitated.
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A nurse is caring for a client with colorectal cancer and learns that a point mutation occurred in the RAS gene. What pathophysiologic process should the nurse consider while planning care? Correct 2 A proto-oncogene converted to an oncogene
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A point mutation in the RAS gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. Activating point mutations in RAS are found in many cancers, especially pancreatic and colorectal cancer. A tumor-suppressor gene, if activated, helps prevent cancer, whereas its inactivation can lead to cancer; but those events are separate from a point mutation in the RAS gene. A proto-oncogene is a type of gene; it is not a nongene entity that is converted into a gene.
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A client is receiving chemotherapy. Which complication should the nurse closely monitor for because it is the most deadly?
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Infection is the most significant cause of complications and death in persons with malignant disease. Anemia, bleeding, and clotting are not the most deadly.
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A client with cancer has a hemoglobin level of 8 g/dl. Which prescribed treatment will the nurse provide? Correct 2 Administration of erythropoietin
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Administration of erythropoietin, which stimulates production of erythrocytes, has been effective in correcting anemia (hemoglobin less than 9 g/dl) in persons with cancer. Administration of platelets is given for low platelet count. Administration of white blood cells can be given for low white blood cell count. Administration of granulocyte colony-stimulating factor is given for granulocytopenia.
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A nurse is teaching about characteristics of malignant tumors. Which information should the nurse include in the teaching session? Select all that apply. Metastasis Invasion of surrounding tissues Self-stimulation with growth factors
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Malignant tumors often metastasize and invade surrounding tissues, and their cells often have autocrine (self-stimulating) growth factor stimulation. Cells in malignant tumors divide and proliferate rapidly. Benign tumors have slow growth and low mitotic index.
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A nurse is reviewing targeted cancer screening results of various clients. Which client will be most at risk for adenomas of the colon? A client with an APC mutation
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Familial polyposis coli (adenomas of the colon) is associated with APC mutation. WT1 mutation is associated with Wilms tumor, a childhood cancer of the kidney. NF1 mutation is associated with neurofibromatosis. BRCA1 mutation is associated with inherited breast cancer.
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A client with cancer received chemotherapy and now has a deficiency in circulating platelets. Which term will the nurse use in report to describe this condition? thrombocytopenia
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Many chemotherapeutic drugs are toxic to the bone marrow, often causing granulocytopenia (a decreased number of a particular type of white blood cells) and thrombocytopenia (a decreased number of platelets). Anemia is a deficiency of circulating red blood cells. Leukopenia is a decrease in white blood cells. Leukocytosis is an increase in circulating white blood cells.
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A client has a strong family history of cancer and is thinking about undergoing genetic testing. "If I have the family mutation that causes the proto-oncogenes to become abnormal and turn on too much, then I am at very high risk for developing cancer. Is that right?" Choose the nurse's best response.
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Proto-oncogenes are normal genes; they do not suppress growth or promote cell death. However, in a person with an abnormal proto-oncogene, the proto-oncogene converts into an oncogene, promoting excessive cell proliferation and increasing the risk of cancer-causing mutations.
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A nurse is teaching the staff about genes that normally inhibit cellular proliferation in the normal state of the cell. Which type of gene is the nurse describing?
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Tumor-suppressor genes encode proteins that in their normal state negatively regulate (halt, or "put the brakes on") proliferation. Hence, they also have been referred to as anti-oncogenes. Oncogenes in their normal nonmutant state direct the synthesis of protein that positively accelerates proliferation; in the setting of viral-induced mutation they can contribute to malignancy. A proto-oncogene is an oncogene in its nonmutant state. Telomeres are protective ends or caps on each chromosome.
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A nurse is explaining how a client's cancer cells accumulate faster than the client's normal neighboring cells. Which process is the nurse describing? CLONE EXPANSION
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Clonal expansion or proliferation is the term used to describe the rapid proliferation of a mutated cancer cell and its progeny that outcompete the nearby normal cells. The terms clonal mutation and clonal stimulation do not apply here. There is no such term as clonal reunification.
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A client is newly diagnosed with cervical carcinoma in situ and asks the nurse to explain what this means. What is the nurse's best response?
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Carcinoma in situ means these early stage growths are localized to the epithelium but have not penetrated the local basement membrane or invaded the surrounding stroma. Carcinoma in situ has not metastasized and has not invaded the surrounding tissue.
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A client with cancer has received treatment to shrink the cancer before surgery. Which term should the nurse use to describe the treatment to shrink the cancer?
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Neoadjuvant chemotherapy is given before localized (surgical or radiation) treatment of a cancer. Neoadjuvant therapy can shrink a cancer so that surgery may spare more normal tissue. Adjuvant chemotherapy is given after surgical excision of a cancer. Brachytherapy uses radiation sources (typically a capsule filled with a radionuclide) to be temporarily placed into body cavities that have cancer. Alternative therapies can be biologically harmless or harmful; rarely is there any evidence these approaches are medically effective, and in the worst cases they can be expensive, delay the use of effective therapies, and produce toxic side effects.
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A client has chronic Helicobacter pylori infection and is at most risk for which type of cancer?
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Helicobacter pylori infection, which also causes peptic ulcer disease, is considered a primary risk factor for gastric cancer. It is not associated with colon cancer, breast cancer, or bladder cancer.
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A cancer cell reactivates the gene for telomerase. What action does the nurse expect to happen in the client's cells?
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The gene for telomerase is deactivated in normal differentiated cells. Reactivation of the gene for telomerase creates the capacity for unlimited replication. Cancer cells evade apoptosis by causing a mutation in the p53 tumor-suppressor gene, not by activating telomerase. Cancer cells lose contact inhibition by inactivation of the tumor-suppressor gene retinoblastoma or, conversely, activation of the protein kinases that drive the cell cycle, the cyclin-dependent kinases. Anchorage independence does not relate to telomerase.
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A nurse hears in an interdisciplinary meeting that a client has cancer-causing mutations to proto-oncogenes. How should the nurse interpret this finding?
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Proto-oncogenes promote normal cell division, and cancer-causing mutations allow proto-oncogenes to transform into oncogenes, leading to an increased rate of cell proliferation and growth. Apoptosis leads to cellular destruction. Monoclonal antibodies produced in a laboratory environment are used to treat certain cancers and autoimmune conditions. Decreased cell responsiveness to growth factors would not contribute to the excessive cell proliferation characteristic of cancer; in fact the opposite would occur (decreased cell growth).
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A client is receiving radiation and asks the nurse how radiation works. How should the nurse respond?
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Radiation therapy is used to kill cancer cells while minimizing damage to normal structures. Effective cell killing using radiation also requires good local delivery of oxygen. Radiation produces slow changes in most cancers and irreversible changes in normal tissues as well.
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A nurse is teaching the staff about the mechanisms that allow cells to maintain genomic stability. Which concepts should the nurse include in the teaching session? Select all that apply. Proofreading of DNA replication Enzymatic repair of DNA damage Cellular checkpoints throughout the cell cycle
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Cells have complex mechanisms for trying to maintain genomic stability. These processes include proofreading of DNA replication, enzymatic repair of DNA damage, and implementation of checkpoints to monitor progression through the cell cycle. Irradiation, which produces genomic instability, has been found to induce an increase of growth factors and extracellular matrix as well as an increase in oxidative metabolism, both of which are strongly linked to cellular dysregulation.
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Which carcinogenic agent is used as an antioxidant in the production of rubber and cutting oils?
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Benzidine is a carcinogenic aromatic amine that is used in the production of rubber and cutting oils. Arsenic is a carcinogenic metal that is a byproduct of nonferrous metal production. Asbestos is a carcinogenic natural fiber. Trihalomethanes are cancer-causing agents, which result from the interaction between chlorine and organic chemicals.
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Which dietary teaching should the nurse give to the patient who smokes cigarettes? Correct 2 Increase the intake of foods that contain vitamin B12
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Patients who are already prone to lung cancer because of conditions such as smoking are at a higher risk for lung cancer due to deficiency of vitamin B12. The nurse should advise the patient to maintain adequate levels of vitamin B12. Lycopene-containing foods decrease the risk of lung cancer. Therefore, the nurse should advise the patient to consume lycopene-containing foods. The nurse should advise the patient to decrease the intake of supplements that contain β-carotene because they increase the risk of lung cancer, especially in people who smoke. The nurse should advise the patient to consume foods that contain folic acid because folic acid decreases the risk of lung cancer.
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A nurse is teaching adults at a wellness clinic about melanoma. Which information from the adults indicates teaching was successful? Select all that apply. Melanoma may suddenly appear without warning. Individuals with fair skin and hair color are at risk for melanoma. Intermittent exposure is the strongest solar risk factor for developing melanoma
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Melanomas can appear suddenly without warning or can arise from or near a mole (melanocytic nevus). They most commonly affect individuals with light complexions, light eyes, and fair hair. When detected in the early stages, melanoma is highly curable. Intermittent sun exposure is the strongest solar risk factor for developing melanoma. The causes of melanoma include both genetic and environmental factors.
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A client has cervical cancer. Upon review of the laboratory results, which subtype of the human papillomavirus (HPV) will the nurse most likely observe?
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In most countries, HPV-16 accounts for 50% to 60% of cervical cancer cases, followed by HPV-18 (10% to 12%) and HPV-31 and HPV-45 (4% to 5% each). HPV types correlated with genital warts, HPV-6 and HPV-11, are called low-risk types because they are rarely associated with cancer.
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Which is a solvent that causes liver and biliary cancer?
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Trichloroethylene is a solvent mainly used for degreasing metal parts. It causes liver and biliary cancer. Straight oils are metal-working fluids and mineral oils used in a variety of industries. They cause bladder, laryngeal, lung, rectal, and skin cancers, not liver and biliary cancer. Benzene is a solvent with strong links to leukemia and non-Hodgkin lymphoma, not liver and biliary cancer. Tetrachloroethylene is a solvent that is used for degreasing the metal parts of various machines. It has suspected links to bladder, cervical, and esophageal cancers, not liver and biliary cancer.
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A nurse is teaching a health class about cancers primarily associated with tobacco use. Which response by the class indicates teaching was successful?
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Tobacco use is primarily associated with squamous and small cell adenocarcinomas. Chondrosarcoma, osteosarcoma, and basal cell carcinoma are not associated with tobacco use.
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What is a natural fibrous particle that causes lung cancer? Slilica
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Silica is a natural fibrous particle used in foundries, brick-making, and sand-blasting that causes lung cancer. Benzidine is an aromatic amine associated with bladder cancer. Cadmium is a metal linked to lung cancer but is not a fibrous particle. Trihalomethanes are chlorination byproducts with suspected links to bladder and rectal cancers.
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A client uses an ear-device cell phone every day and is asking about the health risks associated with electromagnetic radiation (EMR) sources and cancer. How should the nurse reply? Correct 1 Use of cell phones for over 10 years has been linked to a small increased risk of some tumors
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Recent meta-analysis indicates that long-term cell phone use (over 10 years) has been linked to a small increased risk of acoustic neuroma, glioma, and parotid gland tumors. Some case-control studies suggest a harmful association between the use of mobile phones and the risk of tumors (risk is highest on the same side of the head that the phone is used, not on the opposite side). A recent review of 10 epidemiologic studies found that 8 studies reported an increased prevalence of adverse neurobehavioral symptoms or cancer in populations living at distances less than 500 meters from base stations.
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Which term should the nurse use to describe the degree to which a client's development is influenced by the environment? development plasticity
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The degree to which an organism's development is influenced by the environment is termed development plasticity, which requires stable gene expression that has been partly modified by epigenetic processes, and is dependent on the interaction of the genome and epigenome. Transgenerational inheritance is the inherited transmission of environmentally caused phenotypes to future generations. Transgenerational effects are the epigenetic alterations of the sex cells (gametes) and are independent of continued environmental exposures. Genomic instability is an increased tendency of the genome to acquire mutations when various processes involved in maintaining and replicating the genome are dysfunctional.
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Which term should the nurse use to describe toxic, mutagenic, and carcinogenic chemicals and compounds that humans are exposed to in the diet or environment?
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Xenobiotic compounds are toxic, mutagenic, and carcinogenic chemicals and compounds that humans are exposed to in their diets or environment. Epigenetic factors refer to chemical modifications that alter the expression of genes or the phenotype without altering the genetic sequence. The directly irradiated cells also can lead to genetic effects in so-called bystander cells or innocent cells (called bystander effects) even though they themselves received no direct radiation exposure. This larger target is sometimes called abscopal, or effects found in other cells or tissue not directly radiated.
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A nurse is discussing the nontargeted effects of ionizing radiation. What is the nurse describing?
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The bystander and genomic instability effects also have been termed "nontargeted" effects. Ionizing radiation acts not only as an initiator of premalignant cell clones but also as a promoter of preexisting premalignant cell alterations that cause mutations; but these facts do not describe the nontargeted effects of ionizing radiation. Developmental plasticity is the degree to which an organism's development is contingent on its environment and does not relate to nontargeted effects. Microribonucleic acid (miRNA) molecules are small RNA molecules that can target gene expression post-transcriptionally. The linear no-threshold relationship and linear-quadratic relationship are models that explain whether low-dose radiation will cause mutations or not.
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A 62-year-old building contractor presented to the public health clinic with persistent cough, shortness of breath, and fatigue. A chest radiograph found multiple tumors in the lungs, which were subsequently diagnosed as lung cancer. The client states that he has never used tobacco products. Which environmental factors may have contributed to the lung cancer? Select all that apply. Occupational exposure to certain chemicals Occupational exposure to toluene in paints
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Occupational exposure to certain chemicals has been found to be a significant risk factor for cancers of the upper respiratory tract, lungs, bladder, and peritoneum. Asbestos was widely used in construction before the 1970s. Toluene in paints has been linked to lung cancers. Occupational exposure to sunlight is a risk factor for squamous cell and basal cell carcinomas, as well as melanoma, but is not a risk factor for lung cancer. Hepatitis B virus is considered oncogenic for liver cancer but is not linked to lung cancer. Routine exposure to dental radiography may slightly increase the risk of cancers of the head and neck or thyroid cancer but has not been linked to lung cancers.
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A nurse is teaching about the mechanisms involved in alcohol-related carcinogenesis. Which mechanism should the nurse include in the teaching session? Generation of reactive oxygen species
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Alcohol promotes carcinogenesis through generation of reactive oxygen species. Induction, not suppression, of cytochrome P-450 2E1 leads to the generation of reactive oxygen species. Increased, not decreased, procarcinogen activation occurs. The bystander effect occurs in radiotherapy, not in alcohol-related carcinogenesis.
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the nurse is conducting a health screening at a local health fair. Which characteristics should the nurse recognize as increasing the risk for developing melanoma? Select all that apply. Fair skinned Nevi and freckles Lesion on the trunk or back of the legs
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Traits associated with a high risk of melanoma are light-colored hair, eyes, and skin; an inability to tan; and a tendency to freckle, sunburn, and develop nevi. Melanoma is often found on the trunk (men) and back of the legs (women). White people develop melanoma 10 times as often as black, Hispanic, or Asian people.
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If a client has aberrant methylation, what can the client experience? Correct 2 Silencing tumor-suppressor genes
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Aberrant methylation can lead to silencing of tumor-suppressor genes. Expression of micro-ribonucleic acids, not aberrant methylation, has been linked to carcinogenesis because they can act as either oncogenes or tumor-suppressor genes. Silencing oncogenes and activating tumor-suppressor genes would decrease the risk of cancer.
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Which cancer should the nurse suspect in a patient with a history of exposure to sulfuric acid?
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Sulfuric acid is a reactive chemical used widely in the production of isopropyl alcohol and ethanol. Constant exposure to sulfuric acid can lead to the development of cancer of the larynx. Leukemia might be caused by exposure to ethylene oxide, ionizing radiations, and solvents such as benzene. Skin cancer might occur due to ultraviolet radiation exposure. Soft tissue sarcoma might occur due to exposure to ionizing radiations, petrochemicals, and metals, such as arsenic.
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A nurse is asked by a coworker what type of damage is considered to be the characteristic lesion of ionizing radiation (IR). How should the nurse respond?
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The double-strand break is considered the characteristic lesion observed for the effects of IR. These ionizations can lead to irreversible or indirect damage from formation and attack by water-based free radicals (radiolysis), not from inhibition or stabilization. Melanocortin-1 is a low-susceptibility gene for melanoma.
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Which dietary component should the nurse suggest when asked by a client for foods to prevent cancer risk?
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Green tea can help decrease cancer risk. Omega-6 fatty acids, refined grain products, and grilled, blackened foods should be avoided.
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Which carcinogenic agent is associated with lung cancer?
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Beryllium is a metal used in aircrafts, nuclear devices, and medical devices. It has a strong causal link to lung cancer. Vinyl chloride is a reactive chemical used in polyvinyl resins for the production of plastic pipes. It causes liver and biliary, soft tissue sarcoma. Ethylene oxide is also a reactive chemical used as a sterilant, disinfectant, and pesticide, which causes leukemia. 1-naphthylamine is an aromatic amine that causes cancer in the bladder.
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A nurse is teaching a health class about the effects of tobacco smoking. Which information should the nurse include in the teaching session? Select all that apply. This activity is carcinogenic. It is more common among men than women. Smokers die 13 to 14 years earlier than nonsmokers.
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Cigarette smoking is carcinogenic and remains the most important cause of cancer. Tobacco smoking is more common among men (23.9% of adults) than women (18.5%). On average, smokers die 13 to 14 years earlier than nonsmokers. The elderly have the lowest percentage of smokers. It is more common among adults living below the poverty level (30.6%) than those at or above the poverty level (20.4%).
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A nurse is teaching adults at a wellness clinic about melanoma. Which information from the adults indicates teaching was successful? Select all that apply. Correct 1 Melanoma may suddenly appear without warning. Correct 3 Individuals with fair skin and hair color are at risk for melanoma. Correct 5 Intermittent exposure is the strongest solar risk factor for developing melanoma.
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Melanomas can appear suddenly without warning or can arise from or near a mole (melanocytic nevus). They most commonly affect individuals with light complexions, light eyes, and fair hair. When detected in the early stages, melanoma is highly curable. Intermittent sun exposure is the strongest solar risk factor for developing melanoma. The causes of melanoma include both genetic and environmental factors.
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A nurse is teaching a health class about dietary factors that can increase the risk of colorectal cancer. Which information from the class indicates teaching was successful? Select all that apply.
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Dietary factors, such as a low-fiber diet, low consumption of fruits and vegetables, low amounts of calcium, and heavy alcohol use are thought to increase the risk of colorectal cancer. Hot beverages are associated with esophageal and oral cancer.
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A client has been diagnosed with a basal cell carcinoma. Which information should the nurse remember when planning care? Select all that apply. The lesion was likely caused by ultraviolet sunlightThe lesion is most likely found on the arms and legs
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Basal cell carcinoma is typically found on sun-exposed areas (arms and legs, not the trunk) in those with fair complexions and is caused by ultraviolet light. The clients often have light hair and light eyes, and they tend to sunburn rather than tan.
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A woman is admitted for suspected melanoma. Which area should the nurse assess first? back to the legs
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Melanomas more commonly occur in body areas less continually exposed to sunlight, such as the trunks in men and the backs of the legs in women. Basal cell carcinoma commonly occurs on the head and neck.
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A nurse is teaching a health class about the effects of ultraviolet radiation (UVR). Which information should the nurse include in the teaching session? Select all that apply. UVR is known to cause specific gene mutations UVR can occur from natural and artificial sources
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Exposure to ultraviolet radiation (UVR) can emanate from natural and artificial sources. UVR is known to cause specific gene mutations. The principal source of exposure for most people is sunlight, not radiation treatments. Skin exposure to UVR and ionizing radiation, as well as chemical (xenobiotic) agents/drugs, produces reactive oxygen species in large quantities that can overwhelm tissue antioxidants and other oxygen-degrading pathways. The degree of skin damage depends on the intensity and wavelength content, not connexons.
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A nurse is teaching a health class about alcohol and cancer risks. Which information should the nurse include in the teaching session? Select all that apply. Alcohol interacts with smoke, increasing the risk of malignant tumors Even persons who have never smoked but consume three or more drinks daily have increased risk of head and neck cancer
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Alcohol interacts with smoke, increasing the risk of malignant tumors. Even persons who have never smoked but consume three or more drinks daily have increased risk of head and neck cancer. Chronic alcohol consumption is strongly linked to risk for cancer of the larynx, esophagus, and liver, but less strongly to breast and colorectal cancer. Even small amounts of alcohol taken on a daily basis increase the risk of breast cancer. The typical alcohol-related cancer diagnosis presents as laryngeal cancer, not pancreatic, in a man in his early 60s.
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A client is concerned about receiving a recommended computed tomography (CT) scan for recurrent abdominal pain because multiple family members passed away as a result of cancer, and the client recently read an article about an increase in cancers linked to the increased use of CT scans. Which are methods of reducing radiation exposure? Select all that apply.
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There are three ways to reduce radiation exposure from CT: (1) reduce radiation doses in individual studies (i.e., use modern scanners), ( 2) substitute ultrasonography with MRI for CT when possible, and (3) take CT scans only when absolutely necessary. CT scans typically have much higher doses of radiation than conventional radiographs. Taking CT scans with slower scanning times would increase radiation exposure. Using CT scans for defensive medicine reasons unnecessarily increases radiation exposure.
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Which information from the health class indicates teaching by the nurse was successful about the cancers that have substantially increased in the United States? Select all that apply.
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1) melanoma, 2) non-Hodgkin lymphoma, 3) testicular (not ovarian) cancer, 4) brain cancer, and thyroid cancer. Stomach cancer has decreased dramatically.
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A nurse is teaching a class about air pollution and cancer. Which information should the nurse include? Select all that apply.
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Radon is a natural radioactive substance; it is one of the elements and is ubiquitous in rock and soil, although usually only in small amounts. It sometimes can be trapped in houses and underground mines, accumulating to a level that poses risk. Indoor pollution is considered worse than outdoor pollution, partly because of cigarette smoke. Environmental tobacco smoke (passive smoking) can cause the formation of reactive oxygen free radicals and thus DNA damage. Because a person inhales about 20,000 L of air a day, even modest contamination of the atmosphere can result in inhaling large amounts of pollutants. Inorganic arsenic, found in underground water, is associated with an increased risk of several cancers, including bladder, skin, and lung cancers.
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Men with obesity who have cancers of which tissues are at increased risk for death? Select all that apply.
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In men with higher body mass index, studies have found higher rates of death from esophageal, stomach, colorectal, liver, gallbladder, pancreatic, prostate, and kidney cancers, as well as from non-Hodgkin lymphoma, multiple myeloma, and leukemia. Skin and brain cancers are not associated with obesity.
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A 62-year-old woman has recently gained weight and now has a body mass index (BMI) of 30.1, a classification of obesity, class 1. What information should the nurse give this client regarding BMI and cancer? Select all that apply.
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Abdominal obesity-related waist/hip ratio is more strongly related to some tumor types than overall obesity. Although the exact ways in which obesity increases cancer risk are not totally understood, possible mechanisms explaining obesity's correlation to increased cancer incidence include insulin resistance and resulting chronic hyperinsulinemia with increased levels of insulin like growth factors and inflammatory mediators. Research has found that lower degrees of obesity are linked with lower increases in cancer deaths and decreased cancer risks. High BMI in women has been linked to greater death rates from colorectal, liver, gallbladder, pancreatic, and kidney cancers; Non-Hodgkin lymphoma; and multiple myeloma, in addition to higher incidence of cancer of the reproductive organs. The mechanisms of obesity-associated cancer risks are unclear and may vary by type of tumor and distribution of body fat.
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Which information from the client indicates to the nurse that teaching was successful about the rising incidence of human papillomavirus (HPV) and oropharyngeal cancers?
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Individuals with P16-positive tumors have a better prognosis than those with P16-negative tumors. HPV-positive oral cancers are possibly associated with sex-related risk factors, whereas HPV-negative cancers are associated with tobacco and alcohol consumption. HPV oropharyngeal cancer causes P16 to be increased.
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A nurse is teaching a health class about how physical activity reduces the risk of cancer. Which information indicates the class understood the types of cancer that can be reduced with activity? Select all that apply.
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Physical activity has been linked to the reduction of breast cancer and colon cancer. Chronic hepatitis C infection has been linked to liver cancer. Chronic alcoholism has been linked to oral, esophageal, and liver cancers. Prostate cancer is linked to age.
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A nurse is teaching how dietary components influence epigenetic factors. Which mechanisms should the nurse include? Select all that apply. Acting directly as mutagens Interfering with mutagen elimination Influencing cellular proliferation Modulating hormonal axes
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Dietary components can act directly as mutagens or interfere with mutagen elimination. Nutritional factors may alter cellular environments by modulating hormonal axes or influencing cellular proliferation (or both). Nutrition cannot change genetic sequence.
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The nurse is formulating a care plan that includes dietary components to reduce cancer risk. Which information could the nurse share with the client? Select all that apply.
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High intake of fruits and vegetables, especially cruciferous vegetables such as broccoli, cauliflower, and cabbage, helps decrease cancer risk. The amount of whole grains should be increased to decrease cancer risk. Lycopene, found in tomatoes, tomato paste, and watermelon, should be increased to decrease cancer risk. Calcium should not exceed 2000 mg/d. Fiber should be increased, but emphasis should be on foods with a lower glycemic index.
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A nurse is teaching the staff about the epigenetic processes. Which information should the nurse include in the teaching session? Select all that apply. Methylation Histone Modifications MicroRNA
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Methylation is the addition of a methyl group (CH3) to the cysteine group, which can shut off a tumor-suppressor gene. Histone modifications such as histone acetylation and alterations in the chromatin can result in silencing of the regulatory genes. Microribonucleic acids (miRNAs) are small RNA molecules that affect gene expression after transcription, and they can modulate protein production in cells; miRNAs can act as oncogenes or tumor-suppressor genes, linking them to carcinogenesis. Methylation, not demethylation, is an epigenetic process. Histone deletions and transfer RNA are not implicated in epigenetic processes.
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The client is a postmenopausal woman who has recently divorced and has confided to the nurse that she has recently signed up for an online dating service and is worried about being sexually active with new partners. What information would be helpful for the nurse to share with the client regarding protection against human papillomavirus (HPV)-induced cancers? Select all that apply.
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Postmenopausal women have been found to experience a second peak prevalence in high-risk HPV. Smoking has been implicated as a risk factor for acquiring high-risk HPV. Research has found that the number of sexual partners increases the risk of HPV exposure, rather than being an independent risk factor. Persistent infection with high-risk HPV is required for the development of invasive cervical cancer. HPV can be transmitted by all forms of genital contact, not just sexual intercourse, so condoms do not necessarily prevent transmission.
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Which phytochemical foods should the nurse suggest to a client for reduction of cancer risk? Select all that apply.
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Tumeric, blueberries, strawberries, broccoli, and cabbage all contain phytochemicals that help reduce cancer risk. Aflatoxin and Chinese-style salted fish are known to cause cancer.
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Upon reviewing the client's information (see chart), which cancer will the nurse monitor for in this client? 30 years work in textile evironments
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Benzidine, which is used widely in the textile industry and in hair dyes, has a strong association with bladder cancer. Asbestos may cause mesothelioma or lung cancer. Bacterial infection from Helicobacter pylori has been associated with stomach cancer. Radiation, benzene (used in the production of plastics, lubricants, and pesticides), and ethylene oxide (used in making resins, films, and antifreeze) can lead to leukemia.
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A nurse is teaching a health class about the effects of ultraviolet radiation (UVR). Which information should the nurse include in the teaching session? Select all that apply.
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Exposure to ultraviolet radiation (UVR) can emanate from natural and artificial sources. UVR is known to cause specific gene mutations. The principal source of exposure for most people is sunlight, not radiation treatments. Skin exposure to UVR and ionizing radiation, as well as chemical (xenobiotic) agents/drugs, produces reactive oxygen species in large quantities that can overwhelm tissue antioxidants and other oxygen-degrading pathways. The degree of skin damage depends on the intensity and wavelength content, not connexons.
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Which risk factors should a nurse tell clients to avoid to reduce their risk of lung cancer? Select all that apply.
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1)Asbestos, 2)arsenic, and 3)radon exposure are associated with the development of lung cancer. 4)Environmental tobacco smoke increases the risk of lung cancer in women and men. Exposure to UV radiation is associated with the development of skin cancers.
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A nurse is teaching about xenobiotics. Which information should the nurse include? Select all that apply.
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Xenobiotics include toxic, mutagenic, and carcinogenic chemicals, and they are transported in the blood by lipoproteins, not through the lymphatic system. High levels of xenobiotics have been found in a variety of substances, including well-done charbroiled beef. Xenobiotics are very common in the average human diet.
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A patient works in the pharmaceutical industry and is regularly exposed to the solvent benzene. For which cancer should the nurse teach the patient precautionary information? non-Hodgkin lymphoma (NHL).
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The patient is regularly exposed to benzene, which is a carcinogenic solvent. This may lead to the development of leukemia and non-Hodgkin lymphoma (NHL). Lung cancer might occur due to carcinogenic agents, such as environmental tobacco smoke, metals, natural fibers, dust, petrochemical products, and certain reactive chemicals, such as mustard gas. Bladder cancer may occur due to the exposure to metal-working fluids and mineral oils. Liver and biliary cancer might occur due to carcinogens, such as vinyl chloride, trichloroethylene (TCE), and polychlorinated biphenyls (PCBs), as well as ionization radiation exposure.
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A nurse is teaching a health class about alcohol and cancer risks. Which information should the nurse include in the teaching session? Select all that apply.
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Alcohol interacts with smoke, increasing the risk of malignant tumors. Even persons who have never smoked but consume three or more drinks daily have increased risk of head and neck cancer. Chronic alcohol consumption is strongly linked to risk for cancer of the larynx, esophagus, and liver, but less strongly to breast and colorectal cancer. Even small amounts of alcohol taken on a daily basis increase the risk of breast cancer. The typical alcohol-related cancer diagnosis presents as laryngeal cancer, not pancreatic, in a man in his early 60s.
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A nurse is teaching a wellness class about the relationship of air pollution to cancer risk. Which information from the class indicates teaching was successful? Select all that apply. Indoor air pollution is considered more carcinogenic than outdoor air pollution. Environmental tobacco smoke is classified as a human carcinogen.
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Indoor air pollution is considered more carcinogenic than outdoor air pollution, partly because of cigarette smoke, which is classified as a human carcinogen. Radon is a naturally radioactive gas that is found in rocks and soils, becoming trapped in houses and underground mines. Because the levels of radon are greater in underground mines than in homes, the risk of lung cancer among miners is increased, even in nonsmokers. Notable outdoor (not indoor) pollutants include ozone, carbon dioxide, particulates, and sulfur dioxide.
