A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

A. Cancer cells typically lose their specialized functions and characteristics that normal cells have. This loss of differentiation is known as dedifferentiation, where cancer cells become less specialized and more primitive in nature. This allows them to proliferate rapidly and invade surrounding tissues.
B. Contact inhibition refers to the normal process where cells stop dividing when they come into contact with neighboring cells. In cancer cells, this mechanism is disrupted, leading to uncontrolled cell growth and proliferation. Cancer cells continue to divide and grow even when they are in close contact with other cells, which contributes to tumor formation and progression.
C. Cancer cells often acquire mutations that impair their ability to repair DNA damage effectively. This can lead to an accumulation of genetic mutations over time, which is a hallmark of cancer development. While some cancer cells may still have mechanisms to repair DNA damage, they are often less efficient compared to normal cells, leading to genomic instability and further mutation accumulation.
D. Normal cells follow a tightly regulated cell cycle with specific checkpoints that ensure orderly progression through phases such as G1, S, G2, and M phases. In contrast, cancer cells often have dysregulated cell cycle control. They may bypass checkpoints that normally control cell division, leading to uncontrolled proliferation and growth.

A. ALS is not caused by a virus or inflammation of the nerves. It is a progressive neurodegenerative disease affecting the motor neurons in the brain and spinal cord.
B. While acetylcholine breakdown is involved in other neurological conditions (such as myasthenia gravis), ALS primarily affects motor neurons and does not directly involve acetylcholine metabolism at the neuromuscular junction.
C. ALS does not typically involve significant inflammation or demyelination (which is more characteristic of conditions like multiple sclerosis). Therefore, reducing CNS inflammation is not a therapeutic target in ALS.
D. Riluzole, the medication prescribed for ALS, works by decreasing the release of glutamate, which is a neurotransmitter that can be toxic to nerve cells in high amounts. In ALS, excessive glutamate release is believed to contribute to motor neuron degeneration. By reducing glutamate release, riluzole may help protect motor neurons and slow the progression of the disease.