2020 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
ADVANCED 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
PATHOPHYSIOL 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:
OGY FNP 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
PRACTICE 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.
QUESTIONS 5. While studying to become chemo-certified, the nurse
reviews some basic concepts about cancer cells. When a client
and ANSWERS
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
1. Following routine colonoscopy screening, a client is told
programmed to die.C) Growth factors prevents
that he had several polyps removed. The client began crying
cancer cells from entering resting (G0) cell cycle phase.D) Cancer
stating, “I just can't deal with cancer. I'm too young.” The nurse
cells will reach a balance between cell birth and cell death rate.E)
responds:A) “Don't worry. We have some great cancer
Cancer cells never reach a flattened growth rate.Ans:
doctors on staff. I'm sure chemo will help you fight it.”B) “Maybe
B, C
if you're lucky, they have stopped it from metastasizing to your
Feedback: One of the reasons cancerous tumors often
liver.”C) “A simple intestinal surgery will cure you.”D) “Most
seem to grow so rapidly relates to the size of the cell pool that is
colon polyps are not cancerous. The biopsy results will direct your
actively engaged in cycling. It has been shown that the cell cycle
care.”Ans: D Feedback:A polyp is a growth that
time of cancerous tissue cells is not necessarily shorter than that
projects from a mucosal surface, such as the intestine. Although
of normal cells. Rather, cancer cells do not die on schedule, and
the term usually implies a benign neoplasm, some malignant
growth factors prevent cells from exiting the cell cycle and
tumors also appear as polyps. Adenomatous polyps are
entering the G0 or noncycling phase. The ratio of dividing cells to
considered precursors to adenocarcinomas of the colon.
resting cells in a tissue mass is called the growth fraction. The
2. A lung biopsy and magnetic resonance imaging have doubling time is the length of time it takes for the total mass of
confirmed the presence of a benign lung tumor in a client. Which cells in a tumor to double. As the growth fraction increases, the
of the following characteristics is associated with this client's doubling time decreases. When normal tissues reach their adult
neoplasm?A) The tumor will grow by expansion and is likely size, an equilibrium between cell birth and cell death is reached.
encapsulated.B) The cells that constitute the tumor are Cancer cells, however, continue to divide until limitations in blood
undifferentiated, with atypical structure.C) If left untreated, supply and nutrients inhibit their growth. When this occurs, the
the client's tumor is likely to metastasize.D) The tumor is likely doubling time for cancer cells decreases. The initial growth rate is
to infiltrate the lung tissue that presently surrounds it.Ans: exponential and then tends to decrease or flatten out over time.
A Feedback: Benign neoplasms typically
6. Although growth rate is variable among types of
grow by expansion rather than invasion. As well, they are usually
bacteria, the growth of bacteria is dependent on:A) Biofilm
contained within a fibrous capsule. Malignant tumors are
communicationB) Availability of nutrientsC) An intact protein
associated with undifferentiated cells, metastasis, and infiltration
capsidD) Individual cell motilityAns: B
of surrounding tissue.
3. A newly diagnosed lung cancer client asks how his tumor
spread (metastasized) so fast without displaying many Feedback:
signs/symptoms. The nurse responds that malignant tumors affect
area tissues by:A) Increasing tissue blood flowB) Providing Bacterial growth is dependent upon the availability of
essential nutrientsC) Liberating enzymes and toxinsD) nutrients and physical growth conditions. Bacteria prefer to
Forming fibrous membranesAns: C colonize as biofilm and communicate with other bacteria within
the biofilm, but biofilm is not necessary for growth. Viruses (not
Feedback: Malignant tumors affect area bacteria) form a capsid. Although some bacteria have projections
tissues by liberating enzymes and toxins that destroy tumor for motility, these are not necessary for growth.
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.
,7. Which of the following outpatients are at a greater 9. A client has been diagnosed with Coxiellaburnetii
risk for developing Treponema pallidum, the cause of syphilis? infection. She asked the health care provider how she could
Select all that apply. have gotten this disease. The health care provider's best
response is:
A) A homeless adolescent female performing oral sex
for money A) “Probably while walking outside without your shoes on.”
B) A male who frequents clubs catering to exotic B) “While swimming in an unsanitary pond.”
dancers and sexual favors
C) “Drinking contaminated milk.”
C) A homosexual male couple who have had a
monogamous relationship for the past 20 years D) “Eating undercooked fish.”
D) An older adult female living in a condominium Ans: C
who regularly has sex with three to four different
Feedback:
men/week
In humans, Coxiella infection produces a disease called Q
Ans: A, B, D
fever, characterized by a nonspecific febrile illness often
Feedback: accompanied by headache, chills, arthralgias, and mild pneumonia.
The organism produces a highly resistant sporelike stage that is
Treponema pallidum is a sexually transmitted transmitted to humans when contaminated animal tissue is
infection that is spread by direct physical contact. The Borrelia aerosolized (e.g., during meat processing) or by ingestion of
type of spirochete is spread from animals to humans through contaminated milk.
lice or tick bites. Leptospira spirochetes spread from animals to
humans through contact with infected animal urine.
Spirochetes are anaerobic; therefore, they would not invade
the host through oxygen-filled aerobic lungs.
10. A teenage male develops a severe case of “athlete's
foot.” He asks, “How did I get this?” The health care worker
explains that certain fungi become infectious (called
dermatophytes) and exhibit which of the following characteristics?
8. Chlamydiaceae have characteristics of both viruses and
bacteria and are a rather common sexually transmitted infectious A) Prefer to grow in warm environments like shoes/socks
organism. After entry into the host, they transform into a
B) Like a moist environment
reticulate body. The health care provider should monitor which of
the following clients for this possible infection? Select all that C) Limited to cooler cutaneous surfaces
apply.
D) Need higher blood flow to
A) An adult male who raises a number of exotic birds in
his home survive Ans: C
B) A drug abuser looking to share needles/syringes Feedback:
C) A newborn with a noticeable eye infection Dermatophytes are not able to grow at core body
temperature, preferring the cooler surface skin areas instead
D) A teenager who swims in the lake of moist skin folds. Diseases caused by these organisms,
including ringworm, athlete's foot, and jock itch, are
regularly Ans: A, B, C
collectively called superficial mycoses.
Feedback:
Chlamydiaceae are in the form of an elementary body
11. A male client with a history of angina has presented to
when infectious and outside of the host cell. Once an organism
the emergency department with uncharacteristic chest pain, and
enters the cell, it transforms into a large reticulate body. This
his subsequent ECG reveals T-wave elevation. This finding
undergoes active replication into multiple elementary bodies,
suggests an abnormality with which of the following aspects of
which are then shed into the extracellular environment to initiate
the cardiac cycle?
another infectious cycle. Chlamydial diseases of humans include
sexually transmitted genital infections (Chlamydophila A) Atrial depolarization
trachomatis); ocular infections and pneumonia of newborns (C.
trachomatis); upper and lower respiratory tract infections in B) Ventricular depolarization
children, adolescents, and young adults
C) Ventricular repolarization
(Chlamydophilapneumoniae); and respiratory disease acquired
from infected birds (Chlamydophilapsittaci). D) Depolarization of the AV
node Ans: C
,Feedback:
, The T wave on electrocardiography (ECG) corresponds to and heart rate. Cardiac reserve refers to the maximum percentage
ventricular repolarization. Atrial depolarization is represented by of increase in cardiac output that can be achieved above the
the P wave and ventricular depolarization by the QRS complex. The normal resting level.
isoelectric or zero line between the P wave and the Q wave
represents depolarization of the AV node, bundle branches, and
Purkinje system.
14. A client with a history of heart failure has been
referred for an echocardiogram. Results of this diagnostic test
reveal the following findings: heart rate 80 beats/minute; end-
12. During ventricular systole, closure of the diastolic volume 120 mL; and end-systolic volume 60 mL. What is
atrioventricular (AV) valves coincides with: this client's ejection fraction?
A) Atrial chamber filling A) 200 mL
B) Aortic valve opening B) 50%
C) Isovolumetric contraction C) 0.80
D) Semilunar valves opening D) 180 mL
Ans: C Ans: B
Feedback: Feedback:
Ventricular systole is divided into two parts: Ejection fraction = stroke volume ÷ end-diastolic volume,
isovolumetric contraction when the AV valves close and ventricles whereas stroke volume equals the difference between end-
fill; and the ejection period, when the semilunar valves open and diastolic and end-systolic volume. Therefore, EF = 60 ÷ 120, or
blood is ejected through the aortic valve into circulation. 50%.
Immediately after closure of the AV valves, there is a 0.02- to 0.03-
second period during which the pulmonic and aortic valves remain
closed. During this period, the ventricular volume remains the
same while the ventricles contract, producing an abrupt increase
in pressure. At the end of systole, the ventricles relax, causing a 15. Preload represents the volume work of the heart and
precipitous fall in intraventricular pressures. As this occurs, blood is largely determined by:
from the large arteries flows back toward the ventricles, causing
the aortic and pulmonic valves to snap shut—an event marked by A) Venous blood return
the second heart sound.
B) Vascular resistance
C) Force of contraction
D) Ventricular emptying
13. A heart failure client has an echocardiogram performed
Ans: A
revealing an ejection fraction (EF) of 40%. The nurse knows this
EF is below normal and explains to the client: Feedback:
A) “This means you have a lot of pressure built-up Preload represents the amount of blood the heart must
inside your heart.” pump with each beat and represents the volume of blood
stretching the ventricular muscle fibers at the end of diastole.
B) “This means your heart is not pumping as much blood
Pressure (resistance), contraction, and ventricular emptying relate
out of the heart with each beat.”
to afterload.
C) “You need to increase the amount of exercise you do
to get your heart muscle back in shape.”
D) “Your ventricular muscle is getting too stiff to
beat normally.”
Ans: B
Feedback:
Ejection fraction is the percentage of diastolic volume 16. Which of the following clients coming to a small
ejected from the heart [left ventricle] during systole. Stroke volume free clinic are at high risk for malnutrition? Select all that
is determined by the difference between end-diastolic and end- apply.
systolic volumes. Cardiac output is determined by stroke volume
A) An 88-year-old senior citizen on a fixed budget
diagnosed “cancer in situ of the cervix.” The client asks, “What
does this mean?” From the following statements, which is most
ADVANCED 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
PATHOPHYSIOL 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:
OGY FNP 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
PRACTICE 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.
QUESTIONS 5. While studying to become chemo-certified, the nurse
reviews some basic concepts about cancer cells. When a client
and ANSWERS
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
1. Following routine colonoscopy screening, a client is told
programmed to die.C) Growth factors prevents
that he had several polyps removed. The client began crying
cancer cells from entering resting (G0) cell cycle phase.D) Cancer
stating, “I just can't deal with cancer. I'm too young.” The nurse
cells will reach a balance between cell birth and cell death rate.E)
responds:A) “Don't worry. We have some great cancer
Cancer cells never reach a flattened growth rate.Ans:
doctors on staff. I'm sure chemo will help you fight it.”B) “Maybe
B, C
if you're lucky, they have stopped it from metastasizing to your
Feedback: One of the reasons cancerous tumors often
liver.”C) “A simple intestinal surgery will cure you.”D) “Most
seem to grow so rapidly relates to the size of the cell pool that is
colon polyps are not cancerous. The biopsy results will direct your
actively engaged in cycling. It has been shown that the cell cycle
care.”Ans: D Feedback:A polyp is a growth that
time of cancerous tissue cells is not necessarily shorter than that
projects from a mucosal surface, such as the intestine. Although
of normal cells. Rather, cancer cells do not die on schedule, and
the term usually implies a benign neoplasm, some malignant
growth factors prevent cells from exiting the cell cycle and
tumors also appear as polyps. Adenomatous polyps are
entering the G0 or noncycling phase. The ratio of dividing cells to
considered precursors to adenocarcinomas of the colon.
resting cells in a tissue mass is called the growth fraction. The
2. A lung biopsy and magnetic resonance imaging have doubling time is the length of time it takes for the total mass of
confirmed the presence of a benign lung tumor in a client. Which cells in a tumor to double. As the growth fraction increases, the
of the following characteristics is associated with this client's doubling time decreases. When normal tissues reach their adult
neoplasm?A) The tumor will grow by expansion and is likely size, an equilibrium between cell birth and cell death is reached.
encapsulated.B) The cells that constitute the tumor are Cancer cells, however, continue to divide until limitations in blood
undifferentiated, with atypical structure.C) If left untreated, supply and nutrients inhibit their growth. When this occurs, the
the client's tumor is likely to metastasize.D) The tumor is likely doubling time for cancer cells decreases. The initial growth rate is
to infiltrate the lung tissue that presently surrounds it.Ans: exponential and then tends to decrease or flatten out over time.
A Feedback: Benign neoplasms typically
6. Although growth rate is variable among types of
grow by expansion rather than invasion. As well, they are usually
bacteria, the growth of bacteria is dependent on:A) Biofilm
contained within a fibrous capsule. Malignant tumors are
communicationB) Availability of nutrientsC) An intact protein
associated with undifferentiated cells, metastasis, and infiltration
capsidD) Individual cell motilityAns: B
of surrounding tissue.
3. A newly diagnosed lung cancer client asks how his tumor
spread (metastasized) so fast without displaying many Feedback:
signs/symptoms. The nurse responds that malignant tumors affect
area tissues by:A) Increasing tissue blood flowB) Providing Bacterial growth is dependent upon the availability of
essential nutrientsC) Liberating enzymes and toxinsD) nutrients and physical growth conditions. Bacteria prefer to
Forming fibrous membranesAns: C colonize as biofilm and communicate with other bacteria within
the biofilm, but biofilm is not necessary for growth. Viruses (not
Feedback: Malignant tumors affect area bacteria) form a capsid. Although some bacteria have projections
tissues by liberating enzymes and toxins that destroy tumor for motility, these are not necessary for growth.
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.
,7. Which of the following outpatients are at a greater 9. A client has been diagnosed with Coxiellaburnetii
risk for developing Treponema pallidum, the cause of syphilis? infection. She asked the health care provider how she could
Select all that apply. have gotten this disease. The health care provider's best
response is:
A) A homeless adolescent female performing oral sex
for money A) “Probably while walking outside without your shoes on.”
B) A male who frequents clubs catering to exotic B) “While swimming in an unsanitary pond.”
dancers and sexual favors
C) “Drinking contaminated milk.”
C) A homosexual male couple who have had a
monogamous relationship for the past 20 years D) “Eating undercooked fish.”
D) An older adult female living in a condominium Ans: C
who regularly has sex with three to four different
Feedback:
men/week
In humans, Coxiella infection produces a disease called Q
Ans: A, B, D
fever, characterized by a nonspecific febrile illness often
Feedback: accompanied by headache, chills, arthralgias, and mild pneumonia.
The organism produces a highly resistant sporelike stage that is
Treponema pallidum is a sexually transmitted transmitted to humans when contaminated animal tissue is
infection that is spread by direct physical contact. The Borrelia aerosolized (e.g., during meat processing) or by ingestion of
type of spirochete is spread from animals to humans through contaminated milk.
lice or tick bites. Leptospira spirochetes spread from animals to
humans through contact with infected animal urine.
Spirochetes are anaerobic; therefore, they would not invade
the host through oxygen-filled aerobic lungs.
10. A teenage male develops a severe case of “athlete's
foot.” He asks, “How did I get this?” The health care worker
explains that certain fungi become infectious (called
dermatophytes) and exhibit which of the following characteristics?
8. Chlamydiaceae have characteristics of both viruses and
bacteria and are a rather common sexually transmitted infectious A) Prefer to grow in warm environments like shoes/socks
organism. After entry into the host, they transform into a
B) Like a moist environment
reticulate body. The health care provider should monitor which of
the following clients for this possible infection? Select all that C) Limited to cooler cutaneous surfaces
apply.
D) Need higher blood flow to
A) An adult male who raises a number of exotic birds in
his home survive Ans: C
B) A drug abuser looking to share needles/syringes Feedback:
C) A newborn with a noticeable eye infection Dermatophytes are not able to grow at core body
temperature, preferring the cooler surface skin areas instead
D) A teenager who swims in the lake of moist skin folds. Diseases caused by these organisms,
including ringworm, athlete's foot, and jock itch, are
regularly Ans: A, B, C
collectively called superficial mycoses.
Feedback:
Chlamydiaceae are in the form of an elementary body
11. A male client with a history of angina has presented to
when infectious and outside of the host cell. Once an organism
the emergency department with uncharacteristic chest pain, and
enters the cell, it transforms into a large reticulate body. This
his subsequent ECG reveals T-wave elevation. This finding
undergoes active replication into multiple elementary bodies,
suggests an abnormality with which of the following aspects of
which are then shed into the extracellular environment to initiate
the cardiac cycle?
another infectious cycle. Chlamydial diseases of humans include
sexually transmitted genital infections (Chlamydophila A) Atrial depolarization
trachomatis); ocular infections and pneumonia of newborns (C.
trachomatis); upper and lower respiratory tract infections in B) Ventricular depolarization
children, adolescents, and young adults
C) Ventricular repolarization
(Chlamydophilapneumoniae); and respiratory disease acquired
from infected birds (Chlamydophilapsittaci). D) Depolarization of the AV
node Ans: C
,Feedback:
, The T wave on electrocardiography (ECG) corresponds to and heart rate. Cardiac reserve refers to the maximum percentage
ventricular repolarization. Atrial depolarization is represented by of increase in cardiac output that can be achieved above the
the P wave and ventricular depolarization by the QRS complex. The normal resting level.
isoelectric or zero line between the P wave and the Q wave
represents depolarization of the AV node, bundle branches, and
Purkinje system.
14. A client with a history of heart failure has been
referred for an echocardiogram. Results of this diagnostic test
reveal the following findings: heart rate 80 beats/minute; end-
12. During ventricular systole, closure of the diastolic volume 120 mL; and end-systolic volume 60 mL. What is
atrioventricular (AV) valves coincides with: this client's ejection fraction?
A) Atrial chamber filling A) 200 mL
B) Aortic valve opening B) 50%
C) Isovolumetric contraction C) 0.80
D) Semilunar valves opening D) 180 mL
Ans: C Ans: B
Feedback: Feedback:
Ventricular systole is divided into two parts: Ejection fraction = stroke volume ÷ end-diastolic volume,
isovolumetric contraction when the AV valves close and ventricles whereas stroke volume equals the difference between end-
fill; and the ejection period, when the semilunar valves open and diastolic and end-systolic volume. Therefore, EF = 60 ÷ 120, or
blood is ejected through the aortic valve into circulation. 50%.
Immediately after closure of the AV valves, there is a 0.02- to 0.03-
second period during which the pulmonic and aortic valves remain
closed. During this period, the ventricular volume remains the
same while the ventricles contract, producing an abrupt increase
in pressure. At the end of systole, the ventricles relax, causing a 15. Preload represents the volume work of the heart and
precipitous fall in intraventricular pressures. As this occurs, blood is largely determined by:
from the large arteries flows back toward the ventricles, causing
the aortic and pulmonic valves to snap shut—an event marked by A) Venous blood return
the second heart sound.
B) Vascular resistance
C) Force of contraction
D) Ventricular emptying
13. A heart failure client has an echocardiogram performed
Ans: A
revealing an ejection fraction (EF) of 40%. The nurse knows this
EF is below normal and explains to the client: Feedback:
A) “This means you have a lot of pressure built-up Preload represents the amount of blood the heart must
inside your heart.” pump with each beat and represents the volume of blood
stretching the ventricular muscle fibers at the end of diastole.
B) “This means your heart is not pumping as much blood
Pressure (resistance), contraction, and ventricular emptying relate
out of the heart with each beat.”
to afterload.
C) “You need to increase the amount of exercise you do
to get your heart muscle back in shape.”
D) “Your ventricular muscle is getting too stiff to
beat normally.”
Ans: B
Feedback:
Ejection fraction is the percentage of diastolic volume 16. Which of the following clients coming to a small
ejected from the heart [left ventricle] during systole. Stroke volume free clinic are at high risk for malnutrition? Select all that
is determined by the difference between end-diastolic and end- apply.
systolic volumes. Cardiac output is determined by stroke volume
A) An 88-year-old senior citizen on a fixed budget
