NURS 223 Medical-Surgical Nursing EXAM

NURS 223 Medical-Surgical Nursing

EXAM 2

• The student nurse learning about cellular regulation understands that which process occurs

during the S phase of the cell cycle?

• Actual division (mitosis)
• Doubling of DNA
• Growing extra membrane
• No reproductive activity

ANS: B

During the S phase, the cell must double its DNA content through DNA synthesis. Actual division, or mitosis, occurs during the M phase. Growing extra membrane occurs in the G1 phase. During the G0 phase, the cell is working but is not involved in any reproductive activity.

• A student nurse asks the nursing instructor what “apoptosis” means. What response by the

instructor is best?

• Growth by cells enlarging
• Having the normal number of chromosomes
• Inhibition of cell growth
• Programmed cell death

ANS: D

Apoptosis is programmed cell death. With this characteristic, organs and tissues function with cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition.

• The nursing instructor explains the difference between normal cells and benign tumor cells.

What information does the instructor provide about these cells?

• Benign tumors grow through invasion of other tissue.
• Benign tumors have lost their cellular regulation from contact inhibition.
• Growing in the wrong place or time is typical of benign tumors.
• The loss of characteristics of the parent cells is called anaplasia.

ANS: C

Benign tumors are basically normal cells growing in the wrong place or at the wrong time.Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells.

• A group of nursing students has entered a futuristic science contest in which they have

“developed” a cure for cancer. Which treatment would most likely be the winning entry?

• Artificial fibronectin infusion to maintain tight adhesion of cells
• Chromosome repair kit to halt rapid division of cancer cells
• Synthetic enzyme transfusion to allow rapid cellular migration
• Telomerase therapy to maintain chromosomal immortality

ANS: A

Cancer cells do not have sufficient fibronectin and so do not maintain tight adhesion with other

cells. This is part of the mechanism of metastasis. Chromosome alterations in cancer cells (aneuploidy) consist of having too many, too few, or altered chromosome pairs. This does not necessarily lead to rapid cellular division. Rapid cellular migration is part of metastasis.Immortality is a characteristic of cancer cells due to too much telomerase.

• Which statement about carcinogenesis is accurate?
• An initiated cell will always become clinical cancer.
• Cancer becomes a health problem once it is 1 cm in size.
• Normal hormones and proteins do not promote cancer growth.
• Tumor cells need to develop their own blood supply.

ANS: D

Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.

• The nurse caring for oncology clients knows that which form of metastasis is the most

common?

• Bloodborne
• Direct invasion
• Lymphatic spread
• Via bone marrow

ANS: A

Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow.

• A nurse is assessing a client with glioblastoma. What assessment is most important?
• Abdominal palpation
• Abdominal percussion
• Lung auscultation
• Neurologic examination

ANS: D

A glioblastoma arises in the brain. The most important assessment for this client is the neurologic examination.

• A nurse has taught a client about dietary changes that can reduce the chances of developing

cancer. What statement by the client indicates the nurse needs to provide additional teaching?

• “Foods high in vitamin A and vitamin C are important.”
• “I’ll have to cut down on the amount of bacon I eat.”
• “I’m so glad I don’t have to give up my juicy steaks.”
• “Vegetables, fruit, and high-fiber grains are important.”

ANS: C

To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct.

• A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse

reads in the client’s chart that the cancer classification is TISN0M0. What does the nurse conclude about this client’s cancer?

• The primary site of the cancer cannot be determined.
• Regional lymph nodes could not be assessed.
• There are multiple lymph nodes involved already.
• There are no distant metastases noted in the report.

ANS: D

TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis.

• A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer

risk. What response by the nurse is best?

• “Maybe; preservatives, dyes, and preparation methods may be risk factors.”
• “No; research studies have never shown those things to cause cancer.”
• “There are other things you can do that will more effectively lower your risk.”
• “Yes; preservatives and dyes are well known to be carcinogens.”

ANS: A

Dietary factors related to cancer development are poorly understood, although dietary practices are suspected to alter cancer risk. Suspected dietary risk factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer-promoting effects. It is correct to say that other things can lower risk more effectively, but this does not give the client concrete information about how to do so, and also does not answer the client’s question.

• The nursing student learning about cancer development remembers characteristics of normal

cells. Which characteristics does this include? (Select all that apply.)

• Differentiated function
• Large nucleus-to-cytoplasm ratio
• Loose adherence
• Nonmigratory
• Specific morphology

ANS: A, D, E

Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and well- regulated growth.

• The nurse working with oncology clients understands that interacting factors affect cancer

development. Which factors does this include? (Select all that apply.)

• Exposure to carcinogens
• Genetic predisposition
• Immune function
• Normal doubling time
• State of euploidy

ANS: A, B, C

The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function.

• A nurse is participating in primary prevention efforts directed against cancer. In which

activities is this nurse most likely to engage? (Select all that apply.)

• Demonstrating breast self-examination methods to women
• Instructing people on the use of chemoprevention
• Providing vaccinations against certain cancers
• Screening teenage girls for cervical cancer
• Teaching teens the dangers of tanning booths

ANS: B, C, E

Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer.Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods.

• A nurse is providing community education on the seven warning signs of cancer. Which signs

are included? (Select all that apply.)

• A sore that does not heal
• Changes in menstrual patterns
• Indigestion or trouble swallowing
• Near-daily abdominal pain
• Obvious change in a mole

ANS: A, B, C, E

The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign.

Chapter 22: Care of Patients with Cancer

• A nurse in the oncology clinic is providing preoperative education to a client just diagnosed

with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?

• Call the client at home the next day to review teaching.
• Give the client information about a cancer support group.
• Provide all the preoperative instructions in writing.
• Reassure the client that surgery will be over soon.

ANS: A

Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client’s ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is