FNP ADVANCED PATHOPHYSIOLOGY QUESTIONS AND ANSWERS (Updated Version)

1. Following routine colonoscopy screening, a client is told
that he had several polyps removed. The client began crying
stating, “I just can't deal with cancer. I'm too young.” The nurse
responds:A) “Don't worry. We have some great cancer
doctors on staff. I'm sure chemo will help you fight it.”B) “Maybe
if you're lucky, they have stopped it from metastasizing to your
liver.”C) “A simple intestinal surgery will cure you.”D) “Most
colon polyps are not cancerous. The biopsy results will direct your
care.”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.
2. A lung biopsy and magnetic resonance imaging have
confirmed the presence of a benign lung tumor in a client. Which of
the following characteristics is associated with this client's
neoplasm?A) The tumor will grow by expansion and is likely
encapsulated.B) The cells that constitute the tumor are
undifferentiated, with atypical structure.C) If left untreated,
the client's tumor is likely to metastasize.D) The tumor is likely
to infiltrate the lung tissue that presently surrounds it.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.
3. A newly diagnosed lung cancer client asks how his tumor
spread (metastasized) so fast without displaying many
signs/symptoms. The nurse responds that malignant tumors affect
area tissues by:A) Increasing tissue blood flowB) Providing
essential nutrientsC) Liberating enzymes and toxinsD)
Forming fibrous membranesAns: 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.
4. A client had a positive Pap smear. The surgeon diagnosed
“cancer in situ of the cervix.” The client asks, “What does this
mean?” From the following statements, which is most appropriate
in response to this question? The tumor has:A) Been walled off
within a strong fibrous capsuleB) Developed a distant
infiltrationC) Not crossed the basement membrane, so it can
be surgically removed with little chance of growing backD)
Grown undifferentiated cells that no longer look like the
tissue from which it aroseAns: 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.
5. While studying to become chemo-certified, the nurse
reviews some basic concepts about cancer cells. When a client asks
about why the tumor grows so fast, the nurse will respond based
on which of the following physiological principles? Select all that
apply.A) Cancer cells have shorter cell cycle 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.
6. Although growth rate is variable among types of bacteria,
the growth of bacteria is dependent on:A) Biofilm
communicationB) Availability of nutrientsC) An intact protein
capsidD) Individual cell motilityAns: B
Feedback:
Bacterial growth is dependent upon the availability of
nutrients and physical growth conditions. Bacteria prefer to
colonize as biofilm and communicate with other bacteria within
the biofilm, but biofilm is not necessary for growth. Viruses (not
bacteria) form a capsid. Although some bacteria have projections
for motility, these are not necessary for growth.