2020 ADVANCED PATHOPHYSIOLOGY FNP PRACTICE QUESTIONS and ANSWERS

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 respo nds: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. 7. Which of the following outpatients are at a greater risk for developing Treponema pallidum, the cause of syphilis? Select all that apply. A) A homeless adolescent female performing oral sex for money B) A male who frequents clubs catering to exotic dancers and sexual favors C) A homosexual male couple who have had a monogamous relationship for the past 20 years D) An older adult female living in a condominium who regularly has sex with three to four different men/week Ans: A, B, D Feedback: Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact. The Borrelia type of spirochete is spread from animals to humans through 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.