Pathophysiology Chapter 3
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: hypertrophy. hyperplasia. atrophy. hypoplasia.
A 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 can cause the cells to atrophy, or reduce in size. Hypoplasia is underdevelopment or incomplete development of a tissue or an organ.
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? Dysplasia Hypertrophy Metaplasia Atrophy
A 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.
Which describes hypertrophy? increased size of the cell change of cell type increased number of cells decreased size of cells
A Hypertrophy is an increase in the size of the cell. A change in the type of cell is metaplasia, an increase in the number of cells is hyperplasia, and a decrease in the size of cells is atrophy.
Which change exemplifies physiologic hypertrophy? Muscle mass increase with exercise Cell size increase with hypoxia Lung size increase in emphysema Heart size increase in hypertension
A 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 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: hypertrophy. hyperplasia. metaplasia. dysplasia.
A In pressure overload, as occurs with hypertension, the muscle cells hypertrophy to increase the amount of functioning tissue.
The nurse in an infectious-disease clinic will primarily treat injuries to tissues and cells caused by: biologic agents. chemical agents. calcification. oncogenic agents.
A Injury from biologic agents derives from bacterial and viral infections. The injuries differ from the other forms because they are able to replicate and can continue to produce their injurious effects. The etiology of infections does not normally include oncogenic agents, chemical agents, or calcifications.
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
A 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 presents for a scheduled Papanicolaou (Pap) test. What type of problem will the clinician examining the cell samples look for? Changes in cell shape, size, and organization Abnormally high numbers of cells in a specified field Presence of unexpected cell types Ischemic changes in cell samples
A 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 statement would a nurse tell a client that best describes a lab finding of metaplasia? "This is a change in cell form as it adapts to increased work demands or threats to survival." "This is a change in the number of cells as they adapt to change." "This is a decrease in the oxygen-carrying capacity of the cells." "This is a decrease in the size of the cell."
A 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.
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.
A 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.
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.
A 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 client who has undergone radiation therapy is expected to have some necrosis of cells. Necrosis is which type of side effect? Irreversible cell damage Reversible apoptosis Cell regeneration Increased metabolism in cells
A Necrosis refers to cell death in an organ or tissue that is still part of a living organism and is not reversible. The other statements do not describe necrosis.
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
A 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.
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. You should take all the medications as prescribed by your health care provider. It is your right to refuse this medication. I will inform the health care provider of your wishes. These medications are safe and most are available over-the-counter as well.
A 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.
A client is admitted with cold exposure. Which assessment findings will the nurse explain as physiologic changes seen 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."
A B C Exposure to cold increases blood viscosity and induces vasoconstriction and leads to hypoxia. Hypoxia in turn can lead to tissue death. Decreased blood flow may lead to hypoxic tissue injury. Edema also results from increased capillary permeability from the vascular changes caused by the cold. Exposure to cold increases blood viscosity.
A client has developed acute encephalopathy from lead toxicity. The nurse will likely assess which manifestations in this client? Select all that apply. Vomiting Ataxia Seizures Papilledema Coma Increase in alertness Increased appetite
A B C D E 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.
Which situation causes atrophy? Select all that apply. Denervation Increased nutrition Disuse Increased endocrine stimulation Decreased blood flow
A C E Atrophy is caused by disuse, denervation, decreased blood flow, decreased endocrine stimulation, and decreased nutrition.
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.
B 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.
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.
B 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? Organ atrophy Compensatory hyperplasia Metaplasia Physiologic hypertrophy
B 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.
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? The presence of fat in the cytoplasm of liver cells was likely the result of a genetic predisposition. This phenomenon may have been reversible if the client had undertaken lifestyle changes. The client may have had high levels of exposure to free radicals early in life. The changes to the client's liver resulted from undiagnosed liver metastases.
B 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 client would be an example of an individual experiencing cellular atrophy? A postnephrectomy client whose remaining kidney enlarges to compensate for the loss A middle-aged female experiencing menopause due to loss of estrogen stimulation 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
B 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 radiologist is reviewing potential types of radiation therapy for a client. Which type of radiation directly breaks down chemical bonds in a cell? non-ionizing radiation ionizing radiation sunlight radiation ultraviolet radiation
B 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. Non-ionizing radiation exerts its 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 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
B Ischemic injuries such as stroke are characterized by impaired cerebral circulation and consequent death of neurons from cellular hypoxia. Apoptosis is programmed cell death and not related to ischemic events. Abnormal DNA synthesis and impaired calcium homeostasis are not direct consequences of lack of blood flow to body cells.
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.
B 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.
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
B 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.
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.
B 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 describes how atrophied cells survive? Through increased levels of functioning Through decreased oxygen consumption Via increased oxygen consumption By relying on other cells to increase workload
B When confronted with a decrease in work or adverse conditions, cells can atrophy to a smaller size and use less oxygen to survive.
What happens as a cell's workload declines? Select all that apply. Insulin levels increase. Oxygen consumption decreases. Protein synthesis decreases. Energy expenditure increases. Cell size decreases.
B C E 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.
Which factor can increase the absorption of lead into a client's system? Increased iron levels in the blood Decreased oxygen in the blood Decreased calcium levels in the blood Increased zinc levels in the blood
C A deficiency in calcium, iron, or zinc increases lead absorption.
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: renal failure. seizures. liver failure. hemorrhage.
C 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.
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 Cellular dehydration Altered cell membrane permeability Retention of lysosomal enzymes
C 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.
Which assessment supports the finding of lead toxicity? Heart rate 70 beats/min Hematocrit 40% Hemoglobin 9 g/dL (90 g/L) Blood pressure 140/90 mm Hg
C 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.
What happens when a cell is confronted with a decrease in work demands? Cell size increases. Energy expenditure increases. Cell becomes smaller. Cell dies.
C As a cell's work demands decrease, the size of the cell decreases or atrophies. The size of the cell does not increase, but energy expenditure decreases. The cell does not die, but it adapts.
A client with pulmonary hypertension has hypertrophy of the heart's right ventricle. Which explanation is appropriate to tell the client? "As cells in your heart die, they get smaller." "Hypertrophy is a result of necrotic changes from hypoxia." "The cells enlarge in your heart from the increased workload." "As your heart works harder, the number of cells increases."
C Hypertrophy is an increase in cell size due to increased work demands. A client with pulmonary hypertension has increased pressure in the lungs, which the right side of the heart must pump against. The increased work causes cells to increase in size. This is different from an increase in the number of cells, which is hyperplasia. Damage from hypoxia is ischemia, and cells that get smaller is called atrophy.
A client is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which aspect of this abnormality? Alkalemia Hypercapnia Hypoxia Hypocapnia
C 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 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 does not pose a risk if it's cloudy or overcast outside. Ultraviolet radiation increases the risk of skin cancer. Ultraviolet radiation damages DNA. Ultraviolet radiation is only a problem in the summer months near the beach.
C D Ultraviolet radiation increases the risk of skin cancer and damages DNA. It is a concern year-round. Eighty percent of the sun's UV rays are able to pass through the clouds and fog. They block most UVB rays but won't block out UVA rays, which penetrate deep into the skin.
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.
D 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.
A nurse working with a pregnant woman explains that breast size increases as a result of which physiologic manifestation? Atrophy Hypertrophy Dysplasia Hyperplasia
D Breast and uterine enlargements during pregnancy are examples of physiologic hyperplasia that results from estrogen stimulation. Hypertrophy represents an increase in cell size and with it an increase in the amount of functioning tissue mass. It results from an increased workload imposed on an organ, which is not the cause of breast enlargement due to pregnancy.
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 mitochondrial growth Increased oxygen consumption Decreased size of organelles
D 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.
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 increased uterine wall resistance the endometrial cells have grown in size, resulting in a thicker uterine wall." "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 androgen levels the cells in your endometrial lining have increased in size causing a thickening." "In response to estrogen levels endometrial cells have increased in number, resulting in a thickening of the endometrium."
D 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.
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? Mechanical Chemical Endogenous Hypoxic
D 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.
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? Gram-negative bacilli enter the cell and disrupt its ability to replicate. Gram-negative bacilli excrete elaborate exotoxins that interfere with cellular production of ATP. Gram-negative bacilli cannot cause harm to the cell; only Gram-positive bacilli can harm the cell. 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. 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.
Which pathophysiologic process is most likely to result in metastatic calcification? Benign prostatic hyperplasia Liver cirrhosis Impaired glycogen metabolism Hyperparathyroidism
D 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.
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
D 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.
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: caseous necrosis. gas gangrene. liquefaction necrosis. dry gangrene.
D 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.
