Chapter 3
Which student statement demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia? A. "I know that cells like neurons have little capacity for hyperplastic growth." B. "A remaining kidney can sometimes undergo hyperplasia in response to one that has been removed." C. "When male clients experience 'an enlarged prostate,' they are describing a form of hypertrophy." PRIMEXAM.COM D. "Clients with cardiomyopathy undergo myocardial hypertrophy with proportional increases in cell length and width."
Answer: A Rationale: Because they do not normally divide, neurons do not undergo hyperplasia. Remaining organs can display hypertrophy, not hyperplasia, and prostate enlargement is a form of hyperplasia. Cardiomyopathic hyperplasia involves greater increases in cell length than width.
The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes that which mechanism is suspected to play a role in the cellular death associated with ALS? A. Apoptosis B. Liquefaction necrosis C. Hypoxic cell injury D. Caseous necrosis
Answer: A Rationale: Although the exact mechanisms of damage are undetermined, ALS is thought to be caused by apoptosis.
Parents bring their 18-month-old child to the emergency room exhibiting behavior changes and vomiting. They are concerned the child ingested something in the older home they are renovating. Laboratory findings indicate low hemoglobin and elevated creatinine. Which diagnostic test should the nurse advocate for first? A. Erythrocyte protoporphyrin (EP) level B. Urine test for a mercury level C. Ultrasound of the kidneys D. Erythrocyte sedimentation rate
Answer: A Rationale: Anemia is a cardinal sign of lead toxicity, which would be reflected by a low hemoglobin. Lead can also cause diffuse kidney damage, which would be reflected by an elevated creatinine. Behavior changes are also seen with this condition. Screening for lead toxicity involves use of capillary blood obtained from a finger stick to measure free erythrocyte protoporphyrin. Given the history of being exposed to an older home under renovation, this should raise the possibility of lead paint exposure. Combined with the presenting symptoms, this makes ruling out lead poisoning the priority over suspected mercury poisoning, which usually results from ingestion of long-lived fish. Ultrasound of the kidney could be done if the presence of lead is ruled out. An erythrocyte sedimentation rate is a nonspecific test for inflammation and not a priority.
A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which statement best captures the rationale underlying the nurse's advice? A. Antioxidants inhibit the actions of reactive oxygen species. B. Antioxidants prevent the formation of superoxide dismutase. C. Antioxidants react nonspecifically with molecules. D. Antioxidants prevent the occurrence of cell dysplasia.
Answer: A Rationale: Antioxidants inhibit the reactions of reactive oxygen species (ROS) with biological structures. Superoxide dismutase is an antioxidant itself, and ROS, not antioxidants, react nonspecifically with molecules. Antioxidants do not prevent the occurrence of cell dysplasia.
A client who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which statement about potential risks of radiation is most accurate? A. "Some clients experience longer-term irritation of skin adjacent to the treatment site." B. "Sometimes you might find that your blood takes longer to clot than normal." C. "The changes that you might see are normally irreversible." D. "The unwanted effects will be limited to the exposed portions of your skin."
Answer: A Rationale: Chronic radiation dermatitis is a consequence of cancer treatment with ionizing radiation. Hypocoagulation is not an identified consequence of radiation exposure, and changes can be both reversible and deeper than the surface of the skin.
As part of a first aid class, a health care instructor is teaching a group of industrial workers about how electrical injuries can cause cell damage. Which statement made by one of the workers indicates that further teaching is necessary? A. "The greater the skin resistance, the greater the amount of deep and systemic damage a victim is likely to incur." B. "The particular pathway that a current takes through the body is very significant." C. "Resistance to flow is the phenomenon that transforms electrical energy into heat." D. "The most severe damage is likely to occur where the current enters and leaves the body."
Answer: A Rationale: High skin resistance is associated with greater local and superficial burns, rather than deep and systemic damage. The pathway is indeed an important factor in the degree of injury, and this is a result of the transformation of current into heat. Damage is most severe at the point of entry and exit.
The nurse is caring for a 45-year-old client undergoing radiotherapy of the mediastinal nodes due to lymphoma. Which interventions should the nurse prioritize? Select all that apply. A. Assessing for fatigue B. Avoiding invasive procedures C. Performing respiratory assessment D. Performing neurologic assessment E. Assessing for urinary retention
Answer: A, B, C Rationale: Radiotherapy on mediastinal lymph nodes would need to be delivered through the sternal area where bone marrow would be affected. This could result in anemia, thrombocytopenia, and neutropenia. This could lead to fatigue, bleeding, and risk for infection, and thus it is important to avoid invasive procedures. As lung tissue could also be affected, respiratory complications are possible, thereby necessitating respiratory assessment. Neither neurologic complications nor urinary retention would be expected for radiotherapy in the mediastinal area.
The nurse is planning care for a group of clients. Which clients should the nurse prioritize as "at risk" for hypercalcemia and advocate for monitoring calcium levels? Select all that apply. A. A client with prolonged immobility B. A client with hypophosphatemia C. A client with hypoparathyroidism D. A client who has breast cancer with bone metastasis E. A client with heart failure who is taking a loop diuretic
Answer: A, B, D Rationale: The major causes of hypercalcemia are hyperparathyroidism; increased mobilization of calcium from bone (as in cancer with metastatic bone lesions); immobilization; and vitamin D intoxication. A low phosphate level will result in higher serum calcium due to the inverse relationship between these two electrolytes. A client taking a loop diuretic is more prone to hypocalcemia as this medication promotes the loss of calcium in urine.
The health care provider is discussing the treatment protocol using ionizing radiation to treat the client's cancer. The client asks, "What side effects can occur with this treatment?" Which response(s) is accurate? Select all that apply. A. Low blood counts B. New-onset seizures C. Excessive diarrhea D. Photosensitivity E. Kidney stone formation
Answer: A, C Rationale: The injurious effects of ionizing radiation vary with the dose, dose rate, and differential sensitivity of the exposed tissue to radiation injury. Because of the effect on DNA synthesis and interfernece with mitosis, rapidly dividing cells of the bone marrow (low blood counts related to hemoglobin, platelets, and white blood cells) and intestine (diarrhea) are much more vulnerable to radiation injury than other tissues such as eyes, brain cells, or the kidney.
The nurse is caring for a client with arterial insufficiency of the left leg with gangrenous wounds on the second and third toes. What characteristics of the wounds should the nurse evaluate as expected? Select all that apply. A. A clear demarcation between the healthy and affected tissue B. Edema to the left lower leg C. Moist wound with evidence of liquefaction D. Diminished pulse strength E. Atrophy to the affected toes F. Darkened appearance of affected tissue
Answer: A, D, E, F Rationale: Due to the lack of arterial blood supply in this client, there would be a diminished pulse strength; the nurse would expect this to be dry gangrene. In dry gangrene the affected body part becomes dry and shrinks. Its color changes to dark brown or black. There would be a clear line of demarcation between the dead tissue of the gangrenous area and the healthy tissue. Wet gangrene is associated with edema and liquefaction but, because there is no issue with venous return in dry gangrene, this would not be seen.
A home health nurse is making a visit to a family with an 8-month-old infant with severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs disease. The parents are asking the nurse why this happened. The nurse will base her answer knowing the root cause of Tay-Sachs is: A. high exposure to lead in the home environment. B. an enzyme defect causing abnormal lipid accumulation in the brain. C. hypoxia caused by placing the infant on his or her abdomen during sleep. D. an increase in bilirubin retention leading to destruction of RBCs.
Answer: B Rationale: Tay-Sachs disease is a genetic disorder resulting from an enzyme defect that results in abnormal lipid accumulation in the brain and other tissues. Lead exposure, hypoxia, and bilirubin retention is not associated with Tay-Sachs disease.
A nurse is triaging clients at a disaster site. Local facilities have different specialized units. To what facility should the nurse send a client who has sustained an electrical injury to his left thigh? A. Cardiac care unit B. Burn unit C. Surgical intensive care unit D. Neurology unit
Answer: B Rationale: An electrical injury to an area containing bone and muscle will have high resistance and create a high degree of local skin burn, so a burn unit is most appropriate. If the injury had been to the torso this may result in more respiratory or cardiac complications. If the client receives surgery, a surgical intensive care unit may be accessed but cardiac care and neurology do not have immediate priority over a burn unit.
A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which assessment finding is most congruent with the client's diagnosis? A. Decreased deep tendon reflexes B. Hemoglobin 9.9 g/dL (99 g/L) C. Diffuse muscle pain D. White blood cells (WBC) 11,000/mm3 (11.0 x 109 /L)
Answer: B Rationale: Anemia is the cardinal sign of lead toxicity. Neither muscle pain, decreased deep tendon reflexes nor changes in WBC levels are associated with lead toxicity.
The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which client on the unit is most likely to experience muscle hypertrophy? A client with: A. urinary incontinence following a cerebrovascular accident (CVA). B. hypertension, obesity, and decreased activity tolerance. C. peripheral edema secondary to heart failure (HF). D. possible rejection symptoms following a liver transplant.
Answer: B Rationale: Hypertension is a common cause of adaptive hypertrophy, in which cardiac muscle cells increase in size in response to the increased work of circulation over time. The other diagnoses are not associated with muscle hypertrophy.
During a myocardial infarction (MI), a client with a 97% occlusion of the left descending artery develops ventricular dysrhythmias due to the amount of ischemia occurring in the myocardium. While providing education about MI's, which statement is most accurate to share with this client? A. Permanent damage will occur in the myocardium if the vessel is not opened within a 1-2 minute window following the occlusion. B. Treatment needs to be sought immediately so that the buildup of lactic acid is limited and cellular changes can be reversed. C. Once the oxygen supply has been occluded, cellular changes are irreversible even if oxygenation is restored. D. The body will grow new genes thru the process of angiogenesis, thereby avoiding any permanent damage to the myocardium.
Answer: B Rationale: Ischemia is characterized by impaired oxygen delivery and impaired removal of metabolic end products such as lactic acid. Ischemia commonly affects blood flow through limited numbers of vessels and produces local tissue injury. In some instances, the cellular changes due to ischemia are reversible if oxygenation is restored. If not restored, permanent damage can occur.
A worker in a warehouse is trying to have children but think he or she has handled "mercury" while cleaning equipment. Which statement by the occupational nurse is most appropriate at this time? A. Usually mercury toxicity appears as skin rashes and lesions. B. Most mercury toxicity involves central nervous system changes. C. You should have all the mercury fillings in your teeth changed to newer products. D. Infertility is caused by too much mercury exposure.
Answer: B Rationale: Mercury is toxic in four forms: mercury vapor, inorganic divalent mercury, methyl mercury, and ethyl mercury. Depending on the form of mercury exposure, toxicity involving the central nervous system and kidney can occur, not the dermal layers of the skin. In the case of dental fillings, the concern involves mercury vapor being released into the mouth. However, the amount of mercury vapor released from fillings is very small.
The nurse is teaching a group of new mothers about postpartum nutrition, when one of the clients states that she was told to avoid eating fish too often due to the risk of mercury poisoning. Which response by the nurse most accurately addresses the clients concerns? A. "You're right. It's best to avoid eating fish, especially while you are breastfeeding." B. "There are some modest risks, but they are only associated with some longliving fish like tuna." C. "Provided you avoid salmon, you likely won't be putting yourself or your child at risk." D. "The risk of mercury toxicity from eating fish has been shown to be insignificant."
Answer: B Rationale: Only long-living fish such as tuna and swordfish concentrate the mercury from sediment in quantities sufficient to pose a risk. It is not necessary to categorically avoid fish, and salmon poses a low risk. Risks are not insignificant, though they are not particularly high.
Which enzyme listed below is responsible for the ability of cancer cells to resist aging and contributes to cellular immortality that is so characteristic of this disease process? A. Oxidoreductase B. Telomerase C. Hydrolase D. Isomerase
Answer: B Rationale: Some cells have telomerase, an enzyme that 'rebuilds' telomeres and lessens or prevents shortening. Cancer cells have high levels of telomerase, which prevents senescence and contributes to the cellular immortality that characterizes cancer.
A young client has just been diagnosed with xeroderma pigmentosum. When teaching this family about this disease, the nurse should emphasize which teaching points? Select all that apply. A. Wash hands thoroughly when working in the garden to prevent infection. B. Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors. C. Apply antibacterial ointment to any break in the skin and cover wounds with bandages. D. The best time to allow the child to play outside is in the evening hours after the sun goes down. E. The best time for this family to go to the beach is in the fall/winter months.
Answer: B, D Rationale: Xeroderma pigmentosum is a genetic disorder where the enzyme needed to repair sunlight-induced DNA damage is lacking. While washing hands and applying antibacterial products to open wounds in important teaching for parents with children, they are not specific for this disease diagnosis. Ultraviolet damage still occurs in the fall/winter months at the beach.
A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which statement best captures an aspect of this client's condition? A. Paget disease, cancer with metastases, or excess vitamin D may have been contributors. B. Increased calcium intake over time may have contributed to the problem. C. The client has possibly undergone damage as a result of calcification following cellular injury. D. The client has possibly exhibited phosphate retention leading to calcium deposits.
Answer: C PRIMEXAM.COM Rationale: Dystrophic calcification is a result of deposition of calcium following cellular injury, such as that which commonly occurs in heart valves. The other options refer to phenomenon associated with metastatic calcification and the associated increases in serum calcium levels.
A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which factor has most likely contributed to the atrophy of the client's muscle cells? A. High levels of insulin and IGF-1 in the client's blood during immobilization B. Denervation of the affected muscles during the time of traction C. A reduction of skeletal muscle use secondary to the traction treatment D. Reduced oxygen consumption and cellular function that ensures muscle cell survival
Answer: C Rationale: Disuse atrophy results from the reduction in skeletal muscle use such as that following encasement in plaster casts or traction. Low levels of insulin and IGF1 contribute to atrophy, and denervation only occurs in paralyzed limbs. Reduced oxygen consumption and cellular function are the mechanisms of cell atrophy but not the causes of the process.
Which client is at high risk for developing dilated cardiomyopathy? A. 17-year-old with a diving injury resulting in paraplegia B. 4-year-old child born with cerebral palsy and confined to a wheelchair C. 44-year-old noncompliant female who forgets to take her hypertensive medications D. 78-year-old Alzheimer client who received a third-degree burn following an oven fire
Answer: C Rationale: In hypertension, the increased workload required to pump blood against an elevated arterial pressure in the aorta results in a progressive increase in LV muscle mass and need for coronary blood flow. The pressure overload causes hypertrophied cells to have greater width and length. Paraplegia, cerebral palsy, and Alzheimer disease do not increase the workload of the cardiac muscle per se.
Which statement most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? PRIMEXAM.COM A. Normal intracellular calcium ion levels are higher than extracellular levels. B. Ischemia and certain toxins cause a decrease in cytosolic calcium. C. Injured cells tend to accumulate calcium. D. Low calcium levels cause an activation of damaging enzymes.
Answer: C Rationale: Injured cells tend to accumulate calcium, though it is unclear whether this is evidence of causation of cell injury. Intracellular calcium levels are normally lower than extracellular levels, and ischemia and certain toxins cause an increase in cytosolic calcium. High calcium levels may cause an activation of damaging enzymes.
A nurse in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which phenomena has contributed to his tissue damage? A. Decreased blood viscosity has resulted in interstitial bleeding. B. Reactive vasodilation has compromised perfusion. C. Autonomic nervous stimulation has resulted in injury. D. Decreased blood flow has induced hypoxia.
Answer: D Rationale: Damage from exposure to cold results from hypoxia, ice crystal formation, and vasoconstriction. Blood viscosity increases, not decreases, and vasoconstriction rather than vasodilation occurs.
Of the following situations, which one would be an example of a maladaptive cellular change? A. 18-year-old body builder who has developed extremely large pectoral muscles following years of weight lifting. B. 31-year-old marathon runner who has developed hypertrophied myocardial cells C. 54-year-old female who has developed ovarian atrophy following loss of estrogen stimulation during menopause D. 44-year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer
Answer: D Rationale: In many adaptive cellular responses, the expression of the differentiation genes is altered. When working with cancer clients, histological grade or differentiation refers to how much the tumor cells resemble normal cells of the same tissue type. In body builders and athletes, cells hypertrophy based on the increase in workload placed on the muscle. Reproductive atrophy is expected due to the loss of estrogen stimulation during menopause.