PATHO: Practice Questions (Chapter 2)
A patient is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which of the following aspects of this abnormality? a) Hypoxia b) Alkalemia c) Hypocapnea d) Hypercapnea
a) Hypoxia Explanation: Lack of oxygen or hypoxia is a common cause of cell injury. Hypocapnea, alkalemia, and hypercapnea 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.
Which of the following assessments supports the finding of lead toxicity? a) Heart rate 70 beats/min b) Hematocrit 40% c) Blood pressure 140/90 mm/Hg d) Hemoglobin 9 g/dL
d) Hemoglobin 9 g/dL 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 of the following should be included in the teaching plan of care for the parents of a child diagnosed with Tay-Sachs disease? a) The primary organ affected is the heart. b) The disorder involves tissue hyperplasia. c) Symptoms are often noted at birth. d) The disorder involves accumulation of abnormal lipids.
d) The disorder involves accumulation of abnormal lipids. Explanation: In Tay-Sachs disease, a genetic disorder, abnormal lipids accumulate in the brain and other tissues, causing motor and mental deterioration beginning at approximately 6 months of age, followed by death at 2 to 5 years of age
A client's condition has resulted in a decrease in work demands of most cells in the body; the anticipated result would be: a) Decreased programmed cellular death b) Increased mitochondrial growth c) Decreased size of organelles d) Increased oxygen consumption
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 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 patient with gastroesophageal reflux disease has metaplasia. Which of the following is the cause? a) Cells are replaced in response to chronic irritation. b) This represents cancerous cells. c) Cells are increased in size due to increased oxygenation. d) These are nonreversible cell changes.
a) Cells are replaced in response to chronic irritation. Explanation: Metaplasia represents a reversible change in which one adult cell type is replaced by another adult cell type in response to chronic irritation and inflammation.
Mercury is a toxic substance, and the hazards of mercury-associated occupational and accidental exposures are well known. What is the primary source of mercury poisoning today? a) Fish such as tuna and swordfish b) Mercury from thermometers and blood pressure machines c) Amalgam fillings in the teeth d) Mercury found in paint that was made before 1990
a) Fish such as tuna and swordfish Explanation: The main source of methyl mercury exposure is from consumption of long-lived fish, such as tuna and swordfish. Although there is mercury in amalgam fillings, the amount of mercury vapor given off by the fillings is very small. Most thermometers today are made without mercury. The same holds true for most blood pressure machines. Lead in paint is a concern, not mercury
A 7 year old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis? a) Hemoglobin 9.9 g/dL b) Diffuse muscle pain. c) White blood cells (WBC) 11,000/mm3 d) Decreased deep tendon reflexes.
a) Hemoglobin 9.9 g/dL Explanation: Anemia is the cardinal sign of lead toxicity. Neither muscle pain, decreased deep tendon reflexes nor changes in WBC levels is associated with lead toxicity
A client has developed heart failure. The doctor reviews the client's chest x-ray and notes that the heart has enlarged. The changes in the size and shape of the heart are the result of: a) Hypertrophy b) Hypoplasia c) Atrophy d) Hyperplasia
a) Hypertrophy Explanation: Cells adapt to changes in their environment and in their work demands by changing their size, number, and characteristics. An increase in work results in cells undergoing hypertrophy and increasing in size. Hyperplasia is an increase in the number of cells in an organ or tissue. A decrease in work demands or adverse environmental conditions results in cells atrophy, or reducing in size. Hypoplasia is underdevelopment or incomplete development of a tissue or an organ
The radiologist is reviewing potential types of radiation therapy for a client. Select the type of radiation that directly breaks down chemical bonds in a cell. a) Ionizing radiation b) Sunlight radiation c) Ultraviolet radiation d) Nonionizing radiation
a) Ionizing radiation Explanation: Ionizing radiation affects cells by causing ionization of molecules and atoms in the cell by directly hitting the target molecules of the cell and/or by producing free radicals that interact with critical cell components. Nonionizing radiation exerts it effects on the cell by causing a vibration and rotation of atoms and molecules. Sunlight is a form of ultraviolet radiation that induces skin damage by reactive oxygen species and by damage to the melanin-producing processes in the skin.
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: a) Moist gangrene b) Internal gangrene c) Gas gangrene d) Dry gangrene
a) 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.
Hypertrophy may occur as the result of normal physiologic or abnormal pathologic conditions. The increase in muscle mass associated with exercise is an example of physiologic hypertrophy. Pathologic hypertrophy occurs as the result of disease conditions and may be adaptive or compensatory. Examples of adaptive hypertrophy are the thickening of the urinary bladder from long-continued obstruction of urinary outflow and the myocardial hypertrophy that results from valvular heart disease or hypertension. What is compensatory hypertrophy? a) When one kidney is removed, the remaining kidney enlarges to compensate for the loss. b) When the body controls myocardial growth by stimulating actin expression to enlarge the heart c) When the body stimulates gene expression to begin a progressive decrease in left ventricular muscle mass d) When the body increases its major organs during times of malnutrition
a) When one kidney is removed, the remaining kidney enlarges to compensate for the loss. Explanation: Compensatory hypertrophy is the enlargement of a remaining organ or tissue after a portion has been surgically removed or rendered inactive. The body does not enlarge its major organs during times of malnutrition. Gene expression, not actin expression, stimulates the body to increase the muscle mass of the heart. Hypertrophy is not a progressive decrease in the size of anything
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 which of the following? a) Systems-level theories b) Cellular theories c) Molecular theories d) Evolutionary theories
b) Cellular theories Explanation: There are a number of cellular theories of senescence that are under investigation, including those that focus on telomere shortening.
A patient is admitted with frostbite. Which of the following will the nurse tell the patient about the changes that have occurred due to cold exposure? a) Cold exposure results in hypertrophy of cells in the affected are b) Cold increases blood viscosity and thrombosis. c) Cold increases the speed of blood flow through vessel d) Cold causes vasodilation and redness.
b) 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 group of elderly residents were commenting on how many cell functions decline with age. One resident commented that many of his friends who lived under large electromagnetic towers seemed to experience aging at an accelerated rate in comparison with residents who lived nearby in lakefront housing. This observation is the basis for which theory on aging? a) Insufficient telomerase enzyme theory b) Error theory associated with DNA damage c) Theories of genetic influences d) Programmed cell receptor theories
b) Error theory associated with DNA damage Explanation: Error theory suggests that aging results from DNA mutation or faulty repair. Another group of theories of aging focuses on programmed cell changes with genetic influences that systematically cause cell senescence. Elimination of receptor sites is not part of aging theory. Telomerase enzyme is thought to reduce the shortening of the chromosomes and loss of telomere DNA with each cell replication
A nurse is assessing a patient who is a body builder. The nurse documents the increased size of the patient's muscle as resulting from which of the following? a) Atrophy b) Hypertrophy c) Dysplasia d) Hyperplasia
b) Hypertrophy Explanation: Hypertrophy represents an increase in cell size and with it an increase in the amount of functioning tissue mass (Fig. 5.2). It results from an increased workload imposed on an organ or body part and is commonly seen in cardiac and skeletal muscle. tissue, which cannot adapt to an increase in workload through mitotic division and formation of more cells.1
The nurse is conducting a physical assessment of a homeless man during a night when the windchill factor is -10 degrees Farenheit. When assessing the man's fingers and toes for frostbite, the nurse looks for which of the following types of cellular injury? a) Endogenous b) Hypoxic c) Mechanical d) Chemical
b) 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.
Which of the following statements is true in relation to lead exposure? a) Lead is absorbed through the skin. b) Lead is absorbed through the gastrointestinal tract or the lungs. c) Increased calcium levels increases the risk of lead poisoning. d) Increased iron increases the risk of lead poisoning.
b) Lead is absorbed through the gastrointestinal tract or the lungs. Explanation: Lead is absorbed through the gastrointestinal tract and the lungs. It is not absorbed through the skin. Decreased calcium and iron increases the risk of lead poisoning.
A 68 year old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client's condition? a) Paget's disease, cancer with metastases or excess vitamin D may have been contributors. b) The client has possibly undergone damage as a result of calcification following cellular injury. c) Increased calcium intake over time may have contributed to the problem. d) The client has possibly exhibited phosphate retention leading to calcium deposits.
b) The client has possibly undergone damage as a result of calcification following cellular injury. Explanation: Dystrophic calcification is a result of deposition of calcium following cellular injury, such as that which commonly occurs in heart valves. Answers A, B and D all refer to phenomenon associated with metastatic calcification and the associated increases in serum calcium levels.
When confronted with a decrease in work demands or adverse environmental conditions, most cells are able to revert to a smaller size and a lower, more efficient level of functioning that is compatible with survival. This decrease in cell size is known as: a) dysplasia b) atrophy c) hyperplasia d) hypertrophy e) metaplasia
b) atrophy Explanation: When confronted with a decrease in work demands or adverse environmental conditions, most cells are able to revert to a smaller size and a lower and more efficient level of functioning that is compatible with survival. This decrease in cell size is called atrophy. Hypertrophy, metaplasia, and hyperplasia are all cellular adaptations that result in greater number or size. Dysplasia is a loss of cellular organization.
Which of the following clients are at high risk for developing dilated cardiomyopathy? a) 17 year old with a diving injury resulting in paraplegia. b) 78 year old Alzheimer's patient who received a third degree burn following an oven fire. c) 44 year old noncompliant female who forgets to take her hypertensive medications. d) 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. Explanation: 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's disease does not increase the workload of the cardiac muscle per se.
A client is experiencing muscle atrophy following two weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the client's muscle cells? a) Reduced oxygen consumption and cellular function that ensures muscle cell survival. b) Denervation of the affected muscles during the time of traction. c) A reduction of skeletal muscle use secondary to the traction treatment. d) High levels of insulin and IGF-1 in the client's blood during immobilization.
c) A reduction of skeletal muscle use secondary to the traction treatment. Explanation: 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 IGF-1 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 of the following statements is true regarding drug therapy and its effects on the body? a) Drugs only have positive effects on cells. b) Drugs do not injure tissues or cells. c) Antineoplastic cells directly damage cells. d) Drugs only have bad effects when they have side effects.
c) 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 of the following? a) Hypoxia b) Cell necrosis c) Apoptosis d) Atrophy
c) 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 breastfeeding).
A client has developed dystrophic calcification as a result of macroscopic deposition of calcium salts. The tissue that would be most affected would be: a) Dead tissue b) Normal tissue c) Injured tissue d) Regenerated tissue
c) Injured tissue Explanation: Pathologic dystrophic calcification occurs in injured tissue. The components of the calcium deposits are derived from the bodies of dead or dying cells as well as from the circulation and interstitial fluid. It also occurs when the tissues have smaller amounts of iron, magnesium, and other minerals. Metastatic calcification occurs in normal tissue
A mother rushes her 4-year-old child to the emergency department after she found an empty Tylenol (acetaminophen) bottle beside her child. The nurse is trying to explain why it is so important to give the child Ipecac to induce vomiting in order to prevent: a) Hemorrhage b) Seizures c) Liver failure d) Renal failure
c) Liver failure Explanation: Acetaminophen, a commonly used over-the-counter analgesic drug, is detoxified in the liver, where small amounts of the drug are converted to a highly toxic metabolite. This metabolite is detoxified by a metabolic pathway that uses a substance normally present in the liver. When large amounts of the drug are ingested, this pathway becomes overwhelmed and toxic metabolites accumulate, causing massive liver necrosis.
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 which of the following? a) Hyperplasia b) Atrophy c) Metaplasia d) Dysplasia
c) 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.
A patient is admitted with an electrical burn and a fractured arm. Which of the following causes the fracture related to the burn? a) The client most likely fell after the electrical injury. b) The client had a predisposing condition. c) The client had violent muscle contractions during the electrical injury. d) The client may have fallen into the electrical cord.
c) The client had violent muscle contractions during the electrical injury Explanation: The most likely scenario is that the client had an injury with alternating current (AC) that is usually more dangerous than direct current as it causes violent muscle contractions that can result in fractures and dislocations.
Which of the following is an example of physiologic hyperplasia? a) Benign prostatic hyperplasia b) Skin warts c) Uterine enlargement in pregnancy d) Endometrial hyperplasia
c) 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
Which of the following statements would a nurse tell a patient that best describes a lab finding of metaplasia? a) "This is a decrease in the oxygen-carrying capacity of the cells." b) "This is a change in the number of cells as they adapt to change." c) "this is a decrease in the size of the cell." d) "This is a change in cell form as it adapts to increased work demands or threats to survival."
d) "This is a change in cell form as it adapts to increased work demands or threats to survival." Explanation: Metaplasiais 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
A nurse is caring for four clients. Select the client at greatest risk for high blood levels of lead. a) A 62-year-old male with hypercalcemia who smokes b) A 30-year-old Caucasian female office worker with asthma c) A 17-year-old Hispanic male student who takes a wood working class d) A 2-year-old anemic child who lives in a turn-of-the-century home
d) A 2-year-old anemic child who lives in a turn-of-the-century home Explanation: The client at the highest risk of having higher blood levels would be a young child who is likely to puts small toys in his or her mouth or ingests lead dust form soil. Factors that increase the risk of lead toxicity include preschool age, low socioeconomic status, and living in older housing built primarily before 1960. A client with a deficiency in calcium (hypocalcemia), iron, or zinc increases his or her risk of lead absorption. Behaviors that include smoking and working around wood have no apparent affect on the development of lead poisoning.
A client's condition has resulted in a decrease in work demands of most cells in the body; the anticipated result would be: a) Decreased programmed cellular death b) Increased mitochondrial growth c) Increased oxygen consumption d) Decreased size of organelles
d) 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 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.
Biologic agents differ from other injurious agents in that they are able to replicate and can continue to produce their injurious effects. How do Gram-negative bacteria cause harm to the cell? a) Gram-negative bacilli enter the cell and disrupt its ability to replicate. b) Gram-negative bacilli cannot cause harm to the cell; only Gram-positive bacilli can harm the cell. c) Gram-negative bacilli excrete elaborate exotoxins that interfere with cellular production of ATP. d) Gram-negative bacilli release endotoxins that cause cell injury and increased capillary permeability.
d) Gram-negative bacilli release endotoxins that cause cell injury and increased capillary permeability Explanation: Gram-negative bacilli release endotoxins that cause cell injury and increased capillary permeability. Certain bacteria excrete elaborate exotoxins that interfere with cellular production of ATP. Gram-negative bacilli do not disrupt a cell's ability to replicate. Many Gram-negative bacilli cause harm to cells
A patient asks why her breasts are enlarged during pregnancy. Which of the following is the best answer? a) Atrophy due to decreased workload b) Decreased workload of the glands c) Increased blood flow to the area d) Hyperplasia due to estrogen stimulation
d) Hyperplasia due to estrogen stimulation Explanation: Physiologic hyperplasia results from estrogen stimulation during pregnancy, causing the breasts and uterus to enlarge
Which of the following exemplifies physiologic hypertrophy? a) Heart size increase in hypertension b) Lung size increase in emphysema c) Cell size increase with hypoxia d) Muscle mass increase with exercise
d) 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
A pregnant client is attending a nutrition class for first-time moms. During the class, the instructor stressed that they should avoid consumption of which food that may cause brain damage from methyl mercury exposure? a) Fresh milk b) Beets c) Raw hamburger d) Tuna
d) Tuna Explanation: The main source of methyl mercury exposure is from consumption of long-lived fish, such as tuna and swordfish. Fish concentrate mercury from sediment in the water. Because the developing brain is more susceptible to mercury-induced damage, it is recommended that young children and pregnant and nursing women should avoid consumption of fish known to contain high mercury content. None of the other foods listed pose a threat of mercury toxicity.
Which of the following should a nurse stress when teaching patients to avoid exposure to lead in the environment? Select all that apply. a) Lead can contaminate soil. b) Avoid flaking paint. c) Not everyone has a reaction to lead. d) Root vegetables can contain more lead than other vegetables. e) Repeated exposure to small amounts of lead is not a problem.
• 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 patients 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 has developed acute encephalopathy from lead toxicity. The nurse is aware that the client may display: Select all that apply. a) Increase in alertness b) Increased appetite c) Seizures d) Vomiting e) Coma f) Papilledema g) Ataxia
• Vomiting • Ataxia • Seizures • Papilledema • Coma Explanation: The most serious manifestation of lead poisoning is acute encephalopathy. It is manifested by persistent vomiting, ataxia, seizures, papilledema, impaired consciousness, and coma. Acute encephalopathy may manifest suddenly, or it may be preceded by other signs of lead toxicity such as behavioral changes or abdominal complaints.
The nurse is providing care for a 21 year old female client with gas gangrene secondary to her compound fracture in her arm. Which of the following assessment finding would the nurse most reasonably expect to find when caring for a client with a diagnosis of gas gangrene? a) Spreading edema b) Inflammation of the affected tissue. c) Impaired alveolar gas exchange d) A positive culture for Staphylococcus
a) Spreading edema Explanation: Spreading edema is a cardinal sign of gas gangrene. It is often caused by Clostridium bacteria, not Staphylococcus. Inflammation may exist at the interface between affected and unaffected tissue, but not in the dead, affected tissue. Impaired gas exchange would not be a sign
Which of the following causes atrophy? Select all that apply. a) Decreased blood flow b) Disuse c) Denervation d) Increased endocrine stimulation e) Increased nutrition.
a) Decreased blood flow b) Disuse c) Denervation Explanation: Atrophy is caused by disuse, denervation, decreased blood flow, decreased endocrine stimulation, and decreased nutrition.
The nurse is teaching a patient about genetic disorders. Which of the following contains the genetic code? a) mRNA b) DNA c) tRNA d) rRNA
b) DNA Explanation: DNA contains genetic code, and injury to DNA can cause a variety of genetic mutations.
What happens as a cell's workload declines? Select all that apply. a) Cell size decreases. b) Insulin levels increase. c) Energy expenditure increases. d) Oxygen consumption decreases. e) Protein synthesis decreases
• Cell size decreases. • Oxygen consumption decreases. • Protein synthesis decreases. Explanation: As the cell's workload declines, oxygen consumption decreases, protein synthesis decreases, and cell size decreases. Insulin levels do not increase, and energy expenditure would decrease.
select the statement the best describes apoptosis. a) Highly selective in eliminating injured or aged cells b) The release of products of cell death is uncontrolled c) Unregulated by enzymatic digestion of cell components d) Responsible for initiating an inflammatory response
a) Highly selective in eliminating injured or aged cells Explanation: Apoptosis is a highly selective process that eliminates injured and aged cells in a manner that maintains the integrity of the plasma membrane and does not initiate inflammation. All the other options describe the occurrences of necrosis.
Which of the following statements is true concerning hyperplasia? a) It is a response to a stimulus. b) It is an abnormal response to stimulation. c) It is an increase in the size of a cell. d) It is an uncontrolled process.
a) It is a response to a stimulus Explanation: Hyperplasia is an increase in the number of cells in an organ, not the size of cells, and is the response to a stimulus that is a controlled process that occurs in response to an appropriate stimulus.
