chapter 3
A client receives a phone call from her gynecologist's office nurse and is informed that her Pap test results identified mild dysplasia. The best explanation for the nurse to provide would be: "You need emergency treatment; please come in to the office today." "Do not be concerned; this is not abnormal." "You definitely have cancer." "Minor degrees of dysplasia are associated with chronic irritation or inflammation. However, we will need to do additional diagnostic studies to confirm the diagnosis."
"Minor degrees of dysplasia are associated with chronic irritation or inflammation. However, we will need to do additional diagnostic studies to confirm the diagnosis." Explanation: Dysplasia is characterized by deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization. Minor degrees of dysplasia are associated with chronic irritation or inflammation. Dysplasia is strongly implicated as a precursor of cancer. Further tests would be needed.
Which statement would a nurse tell a client that best describes a lab finding of metaplasia? "This is a change in the number of cells as they adapt to change." "This is a change in cell form as it adapts to increased work demands or threats to survival." "This is a decrease in the size of the cell." "This is a decrease in the oxygen-carrying capacity of the cells."
"This is a change in cell form as it adapts to increased work demands or threats to survival." Explanation: Metaplasia is a change in the cell's form as it adapts to increased work demands or threats to survival. Hyperplasia is the change in the number of cells, and atrophy and hypertrophy are changes in a cell's size. Hypoxia or hypoxemia are decreases in oxygen.
Which client would be an example of an individual experiencing cellular atrophy? A postnephrectomy client whose remaining kidney enlarges to compensate for the loss A female client with the change in uterine size as a result of pregnancy A hypertensive, noncompliant client who has developed a progressive increase in left ventricular mass A middle-aged female experiencing menopause due to loss of estrogen stimulation
A middle-aged female experiencing menopause due to loss of estrogen stimulation Explanation: In women, the loss of estrogen stimulation during menopause results in atrophic changes in the reproductive organs. Compensatory hypertrophy is the enlargement of a remaining organ or tissue after a portion has been surgically removed or rendered inactive. For instance, if one kidney is removed, the remaining kidney enlarges to compensate for the loss. In hypertension, for example, the increased workload required to pump blood against an elevated arterial pressure results in a progressive increase in left ventricular muscle mass and need for coronary blood flow. The pregnant uterus undergoes both hypertrophy and hyperplasia as a result of estrogen stimulation.
The nurse is caring for a toddler brought into the emergency department for suspected lead toxicity. Which condition or sign is the cardinal indicator of lead toxicity? Anemia Fever Muscle weakness Nausea and vomiting
Anemia Explanation: Anemia is a cardinal sign of lead toxicity. Lead competes with the enzymes required for hemoglobin synthesis and with the membrane-associated enzymes that prevent hemolysis of red blood cells. The resulting red blood cells are coarsely stippled and hypochromic, resembling those seen in iron-deficiency anemia. The lifespan of the red blood cell is also decreased.
Which statement is true regarding drug therapy and its effects on the body? Drugs only have bad effects when they have side effects. Drugs do not injure tissues or cells. Drugs only have positive effects on cells. Antineoplastic cells directly damage cells.
Antineoplastic cells directly damage cells. Explanation: Antineoplastic drugs directly injure cells. Many drugs injure tissues and cells either through their direct mechanism of action, side effects, or adverse effects.
The obstetric nurse explains to the client that when she stops breast-feeding, her breast tissue will reduce in size. The nurse understands that this regression is due to which physiologic process? Apoptosis Telomere shortening Cell necrosis Hypoxia
Apoptosis Explanation: Apoptosis is thought to be responsible for several normal physiologic processes, including hormone-dependent involution of tissues (e.g., the regression of breast tissue after weaning from breast-feeding). Telomeres allow the end of the DNA molecule to be replicated completely.
Which intervention should a nurse stress when teaching clients how to avoid exposure to lead in their environment? Select all that apply. Not everyone has a reaction to lead. Root vegetables can contain more lead than other vegetables. Avoid flaking paint. Adult exposure to the same amounts of lead as young children will have more damage to cells. Lead can contaminate soil.
Avoid flaking paint. Lead can contaminate soil. Root vegetables can contain more lead than other vegetables. Explanation: Lead is a very toxic metal and small amounts can accumulate to reach toxic levels. The nurse should teach clients to avoid flaking paint, especially in older homes, as older paint contains lead. Lead can contaminate soil, and root vegetables tend to contain more lead.
A client's ECG reveals that he is suffering from a myocardial infarction. Prompt interventions are chosen to minimize further myocardial harm. What damage is the care team trying to prevent? Apoptotic tissue damage Oxidative stress-induced damage Cellular hypoxia Cellular atrophy
Cellular hypoxia Explanation: The care team will implement interventions to prevent cellular hypoxia. Oxidative stress cannot be avoided in this situation, and apoptosis does not apply to tissues. Oxygen deprivation does not cause cellular atrophy.
A client presents for a scheduled Papanicolaou (Pap) test. What type of problem will the clinician examining the cell samples look for? Ischemic changes in cell samples Abnormally high numbers of cells in a specified field Presence of unexpected cell types Changes in cell shape, size, and organization
Changes in cell shape, size, and organization Explanation: A Papanicolaou (Pap) test is an example of a diagnostic procedure that tests for the presence of cell dysplasia, i.e., deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization. Unexpected cell types are evidence of metaplasia, whereas ischemic changes are associated with cell hypertrophy. Increases in the number of cells are characterized as hyperplasia
A client is admitted with frostbite. What will the nurse tell the client about the changes that have occurred due to cold exposure? Cold increases blood viscosity and thrombosis. Cold exposure results in hypertrophy of cells in the affected area. Cold causes vasodilation and redness. Cold increases the speed of blood flow through vessel.
Cold increases blood viscosity and thrombosis. Explanation: Cold temperature exposure causes increased blood viscosity and can cause clots to form. Vasoconstriction is induced, and the flow of blood is slowed due to this. Cells do not hypertrophy in response to temperature change.
A client has just learned that his liver has regenerated following partial removal of the liver due to trauma. This regeneration is due to which physiologic principle? Exogenous product accumulation Compensatory hyperplasia Metaplasia Intracellular hypertrophy
Compensatory hyperplasia Explanation: The stimuli that induce hyperplasia may be physiologic or nonphysiologic. There are two common types of physiologic hyperplasia: hormonal and compensatory. The regeneration of the liver that occurs after partial hepatectomy (partial removal of the liver) is an example of compensatory hyperplasia. Endogenous product accumulation results when products that result from inborn errors of metabolism cannot be broken down. Intracellular accumulations represent the buildup of substances that cells cannot immediately use or eliminate. Metaplasia represents a reversible change in which one adult cell type is replaced by another adult cell type.
A client's condition has resulted in a decrease in work demands of most cells in the body. Which change within the cell will likely result from this decrease in work? Decreased programmed cellular death Increased oxygen consumption Decreased size of organelles Increased mitochondrial growth
Decreased size of organelles Explanation: Cell atrophy results in a decreased number and size of cell organelles. With cell atrophy, the cell has decreased oxygen consumption and growth of the mitochondria. The cell decreases in size. When confronted with a decrease in work demands or adverse environmental conditions, most cells are able to revert to a smaller size and to a lower and more efficient level of functioning that is compatible with survival. This decrease in cell size is called atrophy. Cellular death process is not affected.
A client's lab report returns and a nurse is explaining to the client the significance of the changes. The nurse states that the finding is implicated as a precursor of cancer. Which finding was most likely on the lab report? Hypertrophy Metaplasia Atrophy Dysplasia Error: Please make a selection. SUBMIT ANSWER
Dysplasia Explanation: Dysplasia is characterized by deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization. It is strongly implicated as a precursor of cancer.
The nurse is caring for a client with gastroesophageal reflux disease (GERD) who is questioning taking the acid reducing medication because it is "just a little heartburn." What is the nurse's best response? Having uncontrolled GERD can increase your risk for esophageal cancer. It is your right to refuse this medication. I will inform the health care provider of your wishes. You should take all the medications as prescribed by your health care provider. These medications are safe and most are available over-the-counter as well.
Having uncontrolled GERD can increase your risk for esophageal cancer. Explanation: The nurse should address the client's concern about taking the medication by informing the client of the risks associated with stopping treatment. GERD is a primary risk factor for Barrett esophagus and esophageal carcinogenesis. Simply telling the client to take all medications or that there is the right to refuse medications does not inform the decision making.
Which assessment supports the finding of lead toxicity? Hematocrit 40% Hemoglobin 9 g/dL (90 g/L) Blood pressure 140/90 mm Hg Heart rate 70 beats/min
Hemoglobin 9 g/dL (90 g/L) Explanation: Anemia is a cardinal sign of lead toxicity. Lead competes with the enzymes required for hemoglobin synthesis and with the membrane-associated enzymes that prevent hemolysis of red blood cells. The other findings are not necessarily found in lead toxicity.
Which pathophysiologic process is most likely to result in metastatic calcification? Benign prostatic hyperplasia Hyperparathyroidism Liver cirrhosis Impaired glycogen metabolism
Hyperparathyroidism Explanation: Metastatic calcification is a result of markedly increased serum calcium levels. Because the parathyroid gland is responsible for the regulation of serum calcium levels, hyperparathyroidism creates a risk for hypercalcemia and consequent metastatic calcification. Benign prostatic hyperplasia, cirrhosis, and impaired glycogen metabolism are not implicated in cases of metastatic calcification.
A client is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which aspect of this abnormality? Hypocapnia Alkalemia Hypoxia Hypercapnia
Hypoxia Explanation: Lack of oxygen or hypoxia is a common cause of cell injury. Hypocapnia, alkalemia, and hypercapnia are not typical mechanisms of injury. The other common major mechanisms of cell injury are free radical formation, adenosine triphosphate depletion, and disruption of intracellular calcium homeostasis.
A 70-year-old client is being treated for a recent hemorrhagic stroke that has left the client with deficits. These deficits are most likely the result of which mechanisms of cell injury? Hypoxia and adenosine triphosphate (ATP) depletion Free radical injury Impaired calcium homeostasis Interference with DNA synthesis
Hypoxia and adenosine triphosphate (ATP) depletion Explanation: Stroke is characterized by impaired cerebral circulation and consequent death of neurons from cellular hypoxia. Free radical injury, abnormal DNA synthesis, and impaired calcium homeostasis are not direct consequences of lack of blood flow to body cells.
The nurse is conducting a physical assessment of a homeless man during a night when the wind chill factor is -10°F (-23°C). When assessing the man's fingers and toes for frostbite, the nurse looks for which type of cellular injury? Chemical Mechanical Endogenous Hypoxic
Hypoxic Explanation: Exposure to cold increases blood viscosity and induces vasoconstriction by direct action on blood vessels and through reflex activity of the sympathetic nervous system. The resultant decrease in blood flow may lead to hypoxic tissue injury, depending on the degree and duration of cold exposure.
A client has been exposed to ultraviolet (UV) radiation. Which effect from the exposure is the nurse's primary concern? Severe decrease in sebaceous secretions Second-degree sunburn Increase in epidermal wrinkling Increased risk of cancer
Increased risk of cancer Explanation: UV radiation contains increasingly energetic rays that are powerful enough to disrupt intracellular bonds and increase the serious risk of skin cancers. Sunburn, increased wrinkles, and decreased lubrication are less serious in nature.
Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician wants to minimize personal exposure to ionizing radiation. What is the primary rationale for the technician's precautions about radiation exposure? Interferes with DNA synthesis and mitosis Decreases the action potential of rapidly dividing cells Stimulates pathologic cell hypertrophy and hyperplasia Results in the accumulation of endogenous waste products in the cytoplasm
Interferes with DNA synthesis and mitosis Explanation: Radiation has a damaging effect on DNA synthesis and mitosis, a process that is especially harmful to rapidly dividing cells. Radiation does not directly influence the action potential of cells or the accumulation of endogenous waste products. Cell changes such as hypertrophy or hyperplasia may result from radiation exposure, but such changes are secondary to interference with DNA synthesis and mitosis.
A client has an increased serum lactic acid level. The physician understands this is indicative of which disease process? Toxicity of lead exposure Apoptosis Ischemia Free radical injury
Ischemia Explanation: Ischemia is characterized by impaired oxygen delivery and impaired removal of metabolic end products such as lactic acid. Lead is a particularly toxic metal. Small amounts accumulate to reach toxic levels. The toxicity of lead is related to its multiple biochemical effects. It has the ability to inactivate enzymes, compete with calcium for incorporation into bone, and interfere with nerve transmission and brain development. Many injurious agents exert damaging effects through reactive chemical species known as free radicals. Free radicals are highly reactive chemical species with an unpaired electron in the outer orbit. The actions of free radicals may disrupt and damage cells and tissues. Apoptosis is a selective process that eliminates injured and aged cells. In cells and tissues, free radicals react with proteins, lipids, and carbohydrates, thereby damaging cell membranes, inactivating enzymes, and damaging nucleic acids that make up DNA.
A public health nurse is conducting a wellness seminar in which a participant has asked how to minimize the potentially harmful effects of free radicals. What should the nurse recommend? Exercise regularly and take acetylsalicylic acid (ASA) 81 mg daily. Monitor blood glucose levels regularly and avoid tobacco use. Monitor blood cholesterol levels and get sufficient sleep each night. Make dietary changes and limit UV exposure.
Make dietary changes and limit UV exposure. Explanation: The harmful effects of free radicals can be partially mitigated by increasing intake of foods known to be antioxidants. UV radiation causes oxidative damage, so limiting exposure prevents damage. ASA has no known effect on oxidative stress. All of the other listed actions are congruent with health but none directly addresses the effects of oxidative stress.
Which change exemplifies physiologic hypertrophy? Cell size increase with hypoxia Heart size increase in hypertension Lung size increase in emphysema Muscle mass increase with exercise
Muscle mass increase with exercise Explanation: Hypertrophy that occurs as the result of normal physiologic conditions is seen as muscle mass increases with exercise. Heart size increase in hypertension is an example of pathologic increase, as is lung size increase in emphysema and cell increase with hypoxia.
The nurse is caring for a client with compensatory hyperplasia. What is the most likely cause of the hyperplasia? Pregnancy Skin warts Partial hepatectomy Benign prostate enlargement
Partial hepatectomy Explanation: Regeneration of the liver that occurs after partial hepatectomy (i.e., partial removal of the liver) is an example of compensatory hyperplasia. Breast and uterine enlargements during pregnancy are examples of a physiologic hyperplasia that results from estrogen stimulation. Skin warts are an example of hyperplasia caused by growth factors produced by certain viruses, such as the papillomaviruses. Benign prostatic hyperplasia, which is a common disorder of men older than 50 years of age, is thought to be related to the action of androgens.
Mechanical forces that produce tissue trauma would be classified as which type of cellular injury? Physical agent Chemical agent Biologic agents Nutritional factors
Physical agent Explanation: Cell injury can be caused by a number of agents, including physical agents, chemicals, biologic agents, and nutritional factors. Among the physical agents that generate cell injury are mechanical forces that produce tissue trauma, extremes of temperature, electricity, radiation, and nutritional disorders. Chemical agents can cause cell injury through several mechanisms: they can block enzymatic pathways, cause coagulation of tissues, or disrupt the osmotic or ionic balance of the cell. Biologic agents differ from other injurious agents in that they are able to replicate and continue to produce injury. Among the nutritional factors that contribute to cell injury are excesses and deficiencies of nutrients, vitamins, and minerals.
Which statement best identifies the functions of genes during an adaptive cellular response? All gene function is altered but not halted. No gene functions are altered, but normal cell functioning is stopped. The expression of the differentiation genes is altered, but the operating gene remains unaffected. The expression of operating genes is altered, but differentiation genes are unaffected.
The expression of the differentiation genes is altered, but the operating gene remains unaffected. Explanation: In many adaptive cellular responses, the expression of the differentiation genes is altered, but that of the operating genes is unaffected.
Microscopic examination of tissue samples from a deceased client's liver reveal that the hepatocytes contain pathologic vacuoles of fat. The nurse should understand what significance of this finding? This phenomenon may have been reversible if the client had undertaken lifestyle changes. The changes to the client's liver resulted from undiagnosed liver metastases. The presence of fat in the cytoplasm of liver cells was likely the result of a genetic predisposition. The client may have had high levels of exposure to free radicals early in life.
This phenomenon may have been reversible if the client had undertaken lifestyle changes. Explanation: Fatty changes are considered to be reversible. This phenomenon is not known to have a genetic predisposition and it is not the result of metastasis or free radicals.
Which condition is an example of physiologic hyperplasia? Skin warts Uterine enlargement in pregnancy Endometrial hyperplasia Benign prostatic hyperplasia
Uterine enlargement in pregnancy Explanation: Two common types of physiologic hyperplasia are hormonal and compensatory. Breast and uterine enlargements during pregnancy are examples of a physiologic hyperplasia. The other examples are nonphysiologic hyperplasia.
The student is reviewing the aging process. One group of theories of aging involves the shortening of telomeres until a critical minimal length is attained and then senescence ensues. These theories are known as: evolutionary theories. molecular theories. systems-level theories. cellular theories.
cellular theories. Explanation: There are a number of cellular theories of senescence that are under investigation, including those that focus on telomere shortening.
The practitioner examines his client's foot and observes the great toe to be black and dry. The practitioner explains to the client that the dead tissue is caused by: dry gangrene. liquefaction necrosis. gas gangrene. caseous necrosis.
dry gangrene. Explanation: The term gangrene is applied when a considerable mass of tissue undergoes necrosis. Gangrene may be classified as dry or moist. In dry gangrene, the part becomes dry and shrinks, and its color changes to dark brown or black. Dry gangrene usually results from interference with arterial blood supply to a part. Liquefaction necrosis occurs when some of the cells die but their catalytic enzymes are not destroyed. An example of liquefaction necrosis is the softening of the center of an abscess with discharge of its contents. Characteristics of gas gangrene are bubbles of hydrogen sulfide gas in the muscle. Gas gangrene is prone to occur in trauma and compound fractures in which dirt and debris are embedded. Caseous necrosis is a distinctive form of coagulation necrosis in which the dead cells persist indefinitely as soft, cheese-like debris. It is most commonly found in the center of tuberculosis granulomas, or tubercles, and is thought to result from immune mechanisms.
The cardiologist examines a client's echocardiogram and determines that the client has aortic stenosis. The cardiologist explains that a frequent cause of this valve disease is: metastatic calcification. dystrophic calcification. hyperplasia. apoptosis.
dystrophic calcification. Explanation: Dystrophic calcification is commonly seen in atheromatous lesions of advanced atherosclerosis, areas of injury in the aorta and large blood vessels, and damaged heart valves. Calcification of the aortic valve is a frequent cause of aortic stenosis in older adults. Metastatic calcification occurs in normal tissues as a result of increased serum calcium levels. Hyperplasia refers to an increase in the number of cells in an organ or tissue. Apoptosis is a process that eliminates injured and aged cells.
When performing an assessment on a school-aged child, the nurse notes that the mucous membranes along the gum margins have a noticeable blue-colored line. At this point, the nurse should ask the parents about possible: second-hand smoke exposure. congenital heart problems. exposure to lead. liver problems as an infant.
exposure to lead. Explanation: The formation of a blue-colored line along the margins of the gum is one of the diagnostic features of lead poisoning. Liver problems are usually displayed as jaundice (yellowing of the skin/sclera). Congenital heart problems may exhibit cyanosis, but this would not be just in the gum margins. Second-hand smoke exposure may cause accumulation in the lungs.
In a genetic disorder called xeroderma pigmentosum, an enzyme needed to repair sunlight-induced DNA damage is lacking. This autosomal recessive disorder is characterized by: white, scaly patches of skin that appear on black people after they have a sunburn. patches of pink, leathery pigmentation that replace normal skin after a sunburn. photosensitivity and a decreased risk of skin cancer in skin that has been exposed to the sun. extreme photosensitivity and a greatly increased risk of skin cancer in skin that has been exposed to the sun.
extreme photosensitivity and a greatly increased risk of skin cancer in skin that has been exposed to the sun. Explanation: In a genetic disorder called xeroderma pigmentosum, an enzyme needed to repair sunlight-induced DNA damage is lacking. This autosomal recessive disorder is characterized by extreme photosensitivity and a 2000-fold increased risk of skin cancer in sun-exposed skin. Exposure to sun causes the skin to toughen and become leathery feeling, but not in patches of pink pigmented skin. Vitiligo is a benign acquired skin disease of unknown cause, consisting of irregular patches of various sizes totally lacking in pigment and often having hyperpigmented borders. It can appear in the skin of any race and is not scaly. Photosensitivity is a sign of xeroderma pigmentosum, but this disease increases, not decreases, the person's risk of skin cancer.
The nurse explains to the hypertensive client that the increased workload required to pump blood against an elevated arterial pressure results in a progressive increase in left ventricular muscle mass. This is an example of: hyperplasia. hypertrophy. metaplasia. dysplasia.
hypertrophy. Explanation: In pressure overload, as occurs with hypertension, the muscle cells hypertrophy to increase the amount of functioning tissue.
The provider explains to the client, who smokes, that cells in the trachea are substituted with cells that are better able to survive. This process is known as: metaplasia. dysplasia. hyperplasia. atrophy.
metaplasia. Explanation: Metaplasia represents a reversible change in which one adult cell type is replaced by another adult cell type. An example of metaplasia is the adaptive substitution of stratified epithelial cells for the ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker.
The nurse is counseling a heavy smoker about the dangers of smoking. The nurse tells the smoker that due to persistent irritation of the lungs from carcinogens, columnar cells may turn into squamous cells as a method of adaptation known as: metaplasia. dysplasia. hyperplasia. anaplasia.
metaplasia. Explanation: Metaplasia usually occurs in response to chronic irritation and inflammation and allows for substitution of cells that are better able to survive under circumstances in which a more fragile cell type might succumb. An example of metaplasia is the adaptive substitution of stratified squamous epithelial cells for the ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker.
A client with diabetes who is diagnosed with a gangrenous right heel ulcer presents with a wound that has no line of demarcation, is spreading rapidly, and has a foul odor. The health care worker recognizes these manifestations as: moist gangrene. internal gangrene. gas gangrene. dry gangrene.
moist gangrene. Explanation: In moist gangrene, there is no line of demarcation between the normal and diseased tissues, and the spread of tissue damage is rapid. Moist gangrene often results in a foul odor caused by bacterial action at the site. Dry gangrene has a clear demarcation and spreads slowly. Gas and internal gangrene do not apply to this client's symptoms.
