PrepU Chapter 3: Cellular Adaptation, Injury, and Death

Which statement would a nurse tell a client to best describe apoptosis? "Apoptosis is the natural removal of injured or worn out cells." "Apoptosis describes increase in number of cells." "Apoptosis is an increase in the size of cells." "Apoptosis occurs in irreversibly damaged cells."

"Apoptosis is the natural removal of injured or worn out cells."

A client is admitted with cold exposure. How should the nurse explain the changes experienced by the client? Select all that apply. "Decrease in blood flow leads to hypoxia." "Hypoxia leads to tissue injury and death." "Vasoconstriction leads to decreased blood flow to tissues." "Cold decreases edema formation." "Decreased blood viscosity."

"Decrease in blood flow leads to hypoxia." "Hypoxia leads to tissue injury and death." "Vasoconstriction leads to decreased blood flow to tissues."

The nurse is reviewing an ultrasound report for a client that reveals endometrial hyperplasia. The client asks what this finding means. How should the nurse respond? "In response to androgen levels the cells in your endometrial lining have increased in size causing a thickening." "In response to increased uterine wall resistance the endometrial cells have grown in size, resulting in a thicker uterine wall." "In response to estrogen levels endometrial cells have increased in number, resulting in a thickening of the endometrium." "The cells in your uterus are abnormal in size and shape and you will require more tests to know what this means."

"In response to estrogen levels endometrial cells have increased in number, resulting in a thickening of the endometrium." Endometrial hyperplasia is the increased production of endometrial cells caused by excessive estrogen production. This can lead to abnormal menstrual bleeding and is considered a risk factor for developing endometrial cancer. Androgens are male hormones and are not associated with endometrial hyperplasia. Hyperplasia involves only the increase in number of cells and not increased cell size, which is called hypertrophy. Hyperplasia only refers to the number of cells and not abnormal shape, size, or organization; this is called dysplasia.

Which client would be an example of an individual experiencing cellular atrophy? A middle-aged female experiencing menopause due to loss of estrogen stimulation A postnephrectomy client whose remaining kidney enlarges to compensate for the loss A hypertensive, noncompliant client who has developed a progressive increase in left ventricular mass A female client with the change in uterine size as a result of pregnancy

A middle-aged female experiencing menopause due to loss of estrogen stimulation 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.

An older adult client has experienced some hypoxia as a result of chronic respiratory problems. Knowing that oxygen-deprived cells result in an accumulation of lactic acid in the cells, the client may experience which physiologic event? An increase in fat load Altered cell membrane permeability Retention of lysosomal enzymes Cellular dehydration

Altered cell membrane permeability Altered membrane permeability impairs the balance, allowing too much of some and not enough of other substances to flow in and out of the cell. The altered permeability, lack of ATP, and loss of functional surface receptors make it difficult for glucose to enter the cell. Excess fat accumulates because it is unable to move through the damaged membrane. Injury to the lysosomal membranes results in the leakage (not retention) of destructive lysosomal enzymes into the cytoplasm and enzymatic digestion of cell components.

The adult child of an older adult in end-stage heart failure asks the hospice nurse why the parent is dying at age 70 when the grandparents lived to their late 90s. Which statement by the nurse indicates a belief in cellular aging? Aging results from mutations in DNA and its repair mechanisms. Cells have a limited ability to replicate and slow down as they reach their limit. As cells age, they lack sufficient telomerase and begin to shorten and cease replication. The presence of certain genes is associated with diseases that shorten lives.

As cells age, they lack sufficient telomerase and begin to shorten and cease replication. There are a number of cellular theories of senescence that are under investigation. Those theories include telomere shortening, free radical injury, and apoptosis. Telomere are DNA sequences at the end of chromosomes. Each time a cell divides, the telomeres shorten until a critical minimal length is attained, senescence ensures, and further cell replication does not occur.

Which term describes how cells can adapt to changes in threats to survival? Select all that apply. Atrophy Hypertrophy Hyperplasia Necrosis Apoptosis

Atrophy Hypertrophy Hyperplasia

What happens when a cell is confronted with a decrease in work demands? Cell size increases. Energy expenditure increases. Cell becomes smaller. Cell dies.

Cell becomes smaller.

Which process associated with cellular injury is most likely to be reversible? Cell damage resulting from accumulation of fat in the cytoplasm Cellular changes as a result of ionizing radiation Cell damage resulting from accumulation of free radicals Apoptosis

Cell damage resulting from accumulation of fat in the cytoplasm Intracellular accumulation of fat leads to serious cell damage, but this is a potentially reversible effect. Ionizing radiation and damage from free radicals are more likely to be permanent, whereas apoptosis is defined as the permanent removal of injured and aged cells.

A client with gastroesophageal reflux disease has metaplasia. Which explanation is the cause? Cells are replaced in response to chronic irritation. This represents cancerous cells. These are nonreversible cell changes. Cells are increased in size due to increased oxygenation.

Cells are replaced in response to chronic irritation.

The nurse is caring for a client who choked on a peanut and then collapsed. After partially clearing the obstruction, it was noted the client experienced prolonged hypoxia. The nurse anticipates that the resulting cerebral infarction will lead to which phenomenon? Caspase activation Coagulation necrosis Rapid phagocytosis Protein p53 deficiency

Coagulation necrosis Tissue infarction is caused by prolonged oxygen deprivation, and the resulting large group of dead cells coagulates in the damaged area (coagulation necrosis). Apoptosis activates caspases (proteases) early in the process of controlled cell death. Phagocytosis occurs rapidly during apoptosis, so it does not elicit an inflammatory response. Protein p53 activation initiates apoptosis

A client is admitted with frostbite. What will the nurse tell the client about the changes that have occurred due to cold exposure? Cold causes vasodilation and redness. Cold increases blood viscosity and thrombosis. Cold increases the speed of blood flow through vessel. Cold exposure results in hypertrophy of cells in the affected area.

Cold increases blood viscosity and thrombosis. 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.

The client is found to have liver disease, resulting in the removal of a lobe of the liver. Adaptation to the reduced size of the liver leads to which phenomenon in the remaining liver cells? Metaplasia Organ atrophy Compensatory hyperplasia Physiologic hypertrophy

Compensatory hyperplasia Compensatory hyperplasia can be stimulated in response to loss of vital tissue that is capable of regeneration, such as liver cells. Metaplasia involves replacement of one existing cell type with another fully differentiated cell type. Organ atrophy is caused by irreversible loss of cells. Physiologic hypertrophy is increased size of existing cells resulting from increased workload.

Which muscle change places an individual at high risk factor for injury? Decrease in diastolic pressure Decrease in muscle mass Increase in lean mass Decrease in fat mass

Decrease in muscle mass

Which situation causes atrophy? Select all that apply. Disuse Denervation Increased endocrine stimulation Increased nutrition Decreased blood flow

Disuse Denervation Decreased blood flow Atrophy is caused by disuse, denervation, decreased blood flow, decreased endocrine stimulation, and decreased nutrition.

A nurse practitioner is preparing to perform a client's Pap test and is answering the client's questions about the clinical rationale for the procedure. The nurse should describe what phenomenon? Calcification of cervical cells is closely associated with the development of cervical cancer. Cell hypertrophy in the columnar epithelium that covers the cervix is a known risk factor for cancer. Epithelial samples in clients with a high risk for cervical cancer often contain metastatic cells. Dysplasia of the cervical epithelium is associated with a high risk of cancer.

Dysplasia of the cervical epithelium is associated with a high risk of cancer. A Pap test involves a cytologic examination of epithelial cells checking for cell dysplasia, which is associated with cervical cancer. These cells are not prone to metastasis, calcification, or hypertrophy.

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? Amalgam fillings in the teeth Mercury from thermometers and blood pressure machines Mercury found in paint that was made before 1990 Fish such as tuna and swordfish

Fish such as tuna and swordfish

Select the statement that best describes apoptosis. Unregulated by enzymatic digestion of cell components Highly selective in eliminating injured or aged cells Responsible for initiating an inflammatory response The release of products of cell death is uncontrolled.

Highly selective in eliminating injured or aged cells

A 73-year-old male client has developed nocturia, in which he must awaken to void 3 to 4 times nightly. Also, he states that he has occasional urgency and experiences incomplete bladder emptying. This client is likely experiencing the effects of what cell change? Hypertrophy Hyperplasia Atrophy Dystrophy

Hyperplasia The client's signs and symptoms are characteristic of benign prostatic hyperplasia (BPH), in which there is an increase in the number of prostate cells, impeding urination. This is not the result of cell hypertrophy, in which the size of individual cells increases. Cell atrophy and dystrophy are unrelated to the etiology of BPH.

A client has been exposed to ultraviolet (UV) radiation. Which effect from the exposure is the nurse's primary concern? Second-degree sunburn Increased risk of cancer Increase in epidermal wrinkling Severe decrease in sebaceous secretions

Increased risk of cancer

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? Stimulates pathologic cell hypertrophy and hyperplasia Results in the accumulation of endogenous waste products in the cytoplasm Interferes with DNA synthesis and mitosis Decreases the action potential of rapidly dividing cells

Interferes with DNA synthesis and mitosis 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.

Which statement is true in relation to lead exposure? Lead is absorbed through the gastrointestinal tract or the lungs. Lead is absorbed through the skin. Increased calcium levels increase the risk of lead poisoning. Increased iron increases the risk of lead poisoning.

Lead is absorbed through the gastrointestinal tract or the lungs.

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? Monitor blood cholesterol levels and get sufficient sleep each night. Make dietary changes and limit UV exposure. Exercise regularly and take acetylsalicylic acid (ASA) 81 mg daily. Monitor blood glucose levels regularly and avoid tobacco use.

Make dietary changes and limit UV exposure. 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

What happens as a cell's workload declines? Select all that apply. Oxygen consumption decreases. Protein synthesis decreases. Insulin levels increase. Energy expenditure increases. Cell size decreases.

Oxygen consumption decreases. Protein synthesis decreases. Cell size decreases.

How do free radicals damage cells? Reacting with proteins and lipids thereby damaging cell membranes Altering the immune response of the cell Disrupting calcium storage in the cell Inactivating enzymes and mitochondria

Reacting with proteins and lipids thereby damaging cell membranes Free radicals are highly reactive chemical species that can damage cells in several ways. In cells and tissues, free radicals react with proteins, lipids, and carbohydrates, thereby damaging cell membranes. Free radicals modify proteins but do not affect the immune function, calcium storage, or intracellular enzymes of cells.

Which child is at greatest risk of lead toxicity? The child with a lead level of 1 μg/mL (0.05 μmol/L) The child with a lead level of 3 μg/mL (0.14 μmol/L) The child with a lead level of 5 μg/mL (0.24 μmol/L) The child with a lead level of 10 μg/mL (0.48 μmol/L)

The child with a lead level of 10 μg/mL (0.48 μmol/L) The higher the lead level, the greater the risk to the child, with a lead level of 10 μg/mL (0.48 μmol/L) being the highest risk.

A nurse is teaching a class on health promotion and includes information about the risk from ultraviolet radiation. Which concepts should be included in this class? Select all that apply. Ultraviolet radiation, in small doses, poses no risk of skin cancer. Ultraviolet radiation is only a problem in the summer months near the beach. Ultraviolet radiation increases the risk of skin cancer. Ultraviolet radiation damages DNA. Ultraviolet radiation does not pose a risk if it's cloudy or overcast outside.

Ultraviolet radiation increases the risk of skin cancer. Ultraviolet radiation damages DNA.

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? When the body increases its major organs during times of malnutrition When one kidney is removed, the remaining kidney enlarges to compensate for the loss. When the body controls myocardial growth by stimulating actin expression to enlarge the heart When the body stimulates gene expression to begin a progressive decrease in left ventricular muscle mass

When one kidney is removed, the remaining kidney enlarges to compensate for the loss. 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; it is an increase in the size of cells.

A man presents to the emergency department after being out in below-zero weather all night. He asks the nurse why the health care team is concerned about his toes and feet. How would the nurse respond? Cold causes injury to the cells in the body by injuring the blood vessels, making them leak into the surrounding tissue. After being out in the cold all night your toes and feet are frozen and it will be very painful to warm them again, and the health care team is concerned he might be a drug addict. The staff is concerned that you might be a homeless person, and we were wondering how often this has happened to you before and when it will happen again. Your toes and feet are frozen, and there is a concern about how decreased blood flow may lead to the formation of blood clots as we warm them again.

Your toes and feet are frozen, and there is a concern about how decreased blood flow may lead to the formation of blood clots as we warm them again.

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: hypertrophy. atrophy. metaplasia. dysplasia. hyperplasia.

atrophy 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.

The nurse in an infectious-disease clinic will primarily treat injuries to tissues and cells caused by: biologic agents. chemical agents. calcification. oncogenic agents.

biologic agents

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. cellular theories. molecular theories. systems-level theories.

cellular theories. There are a number of cellular theories of senescence that are under investigation, including those that focus on telomere shortening.

The provider removes a cast from a teenager's arm. The client asks why the muscle in the arm is smaller than it was. The provider explains that this reduction is caused by which of the following? Disuse Denervation Inadequate nutrition Ischemia or decreased blood flow

disuse

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: gas gangrene. liquefaction necrosis. dry gangrene. caseous necrosis.

dry gangrene. 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

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: liver problems as an infant. congenital heart problems. exposure to lead. second-hand smoke exposure.

exposure to lead. 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.

Which term describes the process by which an increase in functional demand results in an increased number of cells? atrophy hypertrophy hyperplasia dysplasia

hyperplasia

A 70-year-old client is being treated for a recent ischemic stroke that has left the client with deficits. These deficits likely result from which mechanism of cell injury? apoptosis hypoxia and adenosine triphosphate (ATP) depletion interference with DNA synthesis impaired calcium homeostasis

hypoxia and adenosine triphosphate (ATP) depletion

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, the normal ciliated columnar epithelial cells of the trachea may transform into stratified squamous epithelial cells as a method of adaptation known as: metaplasia. dysplasia. anaplasia. hyperplasia.

metaplasia

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. atrophy. hyperplasia.

metaplasia. 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.