Porths Pathophysiology-- Chapter 1
Pathophysiology
Physiology of altered health, deals with cellular and organ changes that occur with disease and with effects these changes have on total body functions.
How does the body react to the injection of tattoo pigments?
Pigment is encapsulated into residual bodies.
The cell membrane is also called what?
Plasma membrane.
An end-stage renal disease patient has been on peritoneal dialysis at home. Based on their lab work, they regulate the type of solution to infuse into their abdomen. When there is a high concentration of potassium inside the cell (hyperkalemia), the solution infused has a lower concentration so that the potassium ions will diffuse outward. At this point, the cellular membrane is said to be:
Polarized because of the presence of a negative membrane potential.
The nurse is aware of the importance of potassium and sodium for normal physiologic functions of a client. The rapid movement of potassium and sodium in actions is known as:
Primary active transport.
The mitochondria are literally the "power plants" of the cell because they transform organic compounds into energy that is easily accessible to the cell. What do the mitochondria do?
Produce ATP from carbon sources.
The Golgi complex, or Golgi bodies, consists of stacks of thin, flattened vesicles or sacs within the cell. These Golgi bodies are found near the nucleus and function in association with the ER. What is one purpose of the Golgi complex?
Receive proteins and other substances from the cell surface by a retrograde transport mechanism.
Carrier status
Refers to a person who harbors an organism but is not infected, as evidence by antibody response or clinical manifestations. Even though person is not infected they can still infect others
Prognosis
Refers to the probable outcome and prospect of recovery from a disease.
Incidence
Reflects the number of new cases of a disease arising in an at risk population during a specified time.
Case Control Study
A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls),
Symptom
A subjective complaint noted by the person with a disorder.
Acute disorder
A health condition that is relatively severe but self-limiting.
10. As part of a screening program for prostate cancer, men at a senior citizens' center are having their blood levels of prostate-specific antigen (PSA) measured. Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test? A) All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer. B) All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer. C) Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer. D) The test displayed low sensitivity but high specificity.
A) All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.
1. At an international nursing conference, many discussions and breakout sessions focused on the World Health Organization (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply. A) Interests in keeping the elderly population engaged in such activities as book reviews and word games during social time B) Increase in the number of chair aerobics classes provided in the skilled care facilities C) Interventions geared toward keeping the elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D) Providing transportation for renal dialysis patients to and from their hemodialysis sessions E) Providing handwashing teaching sessions to a group of young children
A) Interests in keeping the elderly population engaged in such activities as book reviews and word games during social time B) Increase in the number of chair aerobics classes provided in the skilled care facilities C) Interventions geared toward keeping the elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes E) Providing handwashing teaching sessions to a group of young children
7. Which of the following situations would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply. A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation B) Burning, intense incision pain following surgery to remove a portion of colon due to intestinal aganglionosis C) Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma D) Gradual deterioration in ability to walk unassisted for a patient diagnosed with Parkinson disease E) Loss of short-term memory in a patient diagnosed with Alzheimer disease
A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation C) Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma
16. As part of a community class, student nurses are developing a class to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicles. This is an example of which type of prevention? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prognosis enhancement
A) Primary prevention
8. Laboratory testing is ordered for a male patient during a clinic visit for a routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows that A) a normal value represents the test results that fall within the bell curve. B) if the lab result is above the 50% distribution, the result is considered elevated. C) all lab values are adjusted for gender and weight. D) if the result of a very sensitive test is negative, that does not mean the person is disease free.
A) a normal value represents the test results that fall within the bell curve.
15. A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as A) cohort study. B) cross-sectional study. C) case-control study. D) epidemiological study.
A) cohort study.
11. A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in A) the preclinical stage of disease. B) remission and unlikely to develop hepatitis C. C) the clinical disease stage of hepatitis C. D) the chronic phase of hepatitis C.
A) the preclinical stage of disease.
The Krebs cycle provides a common pathway for the metabolism of nutrients by the body. The Krebs cycle forms two pyruvate molecules. Each of the two pyruvate molecules formed in the cytoplasm from one molecule of glucose yields another molecule of what?
ATP.
The cells of the client's epithelial tissue are tightly bound together by specialized junctions. Select the junctions primarily responsible for preventing cell separation.
Adhering junctions.
The nurse monitors the client's oxygen levels and respiratory status. The nurse is aware that oxygen is necessary for:
Aerobic metabolism.
Disease
An acute or chronic illness that one acquires or is born with that causes physiological dysfunction in one or more body system.
What concept will the nurse need to explain about the purpose and action of chemotherapy to a client with cancer?
Apoptosis.
When discussing the various functions of the cellular parts, the pathophysiology professor asks a group of students, "Where are the primary sites of protein synthesis located in a cell?"
Endoplasmic reticulum.
Cadherins, selectins and some integrins, which are adhesion molecules, depend on which of the following to function in cell adhesion?
Calcium.
4. A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than etiology? A) A client who has been exposed to the Mycobacterium tuberculosis bacterium B) A client who has increasing serum ammonia levels due to liver cirrhosis C) A client who was admitted with the effects of methyl alcohol poisoning D) A client with multiple skeletal injuries secondary to a motor vehicle accident
B) A client who has increasing serum ammonia levels due to liver cirrhosis
9. The laboratory technologists are discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of patients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of patients who do not have cardiac etiologies for their shortness of breath also test positive. Which of the following statements best characterizes this blood test? A) Low validity; high reliability B) High sensitivity; low specificity C) High specificity; low reliability D) High sensitivity; low reliability
B) High sensitivity; low specificity
2. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report? A) The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress. B) The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime. C) The client has a good career with exceptional preventative health care benefits. D) The client lives in an affluent, clean, suburban community with access to many health care facilities.
B) The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.
20. The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals that the patient may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which of the following statements about clinical practice guidelines are accurate? Select all that apply. A) Step-by-step guidelines are usually developed and based primarily on "how it has always been done before." B) The development of evidence-based practice guidelines requires a research review from different studies to develop the most accurate diagnostic method to implement. C) Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. D) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback.
B) The development of evidence-based practice guidelines requires a research review from different studies to develop the most accurate diagnostic method to implement. D) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. E) A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.
6. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the patient's current state of health would be best characterized as a symptom rather than a sign? A) The patient's oxygen saturation is 83% by pulse oxymetry. B) The patient notes that he has increased work of breathing when lying supine. C) The RT hears diminished breath sounds to the patient's lower lung fields bilaterally. D) The patient's respiratory rate is 31 breaths/minute.
B) The patient notes that he has increased work of breathing when lying supine.
A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?
Bronchiectasis due to interferences wth clearance of inhaled bacteria along the respiratory tract.
5. A new myocardial infarction patient requiring angioplasty and stent placement has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the patient verifies to the nurse that he has understood the nurse's teachings about coronary artery disease? A) "All I have to do is stop smoking, and then I won't have any more heart attacks." B) "My artery was clogged by fat, so I will need to stop eating fatty foods like French fries every day." C) "Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery." D) "If I do not exercise regularly to get my heart rate up, blood pools in the veins causing a clot that stops blood flow to the muscle, and I will have a heart attack."
C) "Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery."
14. An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which of the following types of study is the epidemiologist most likely conducting? A) Cohort study B) Cross-sectional study C) Case-control study D) Risk factor study
C) Case-control study
17. A multidisciplinary health care team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which of the following aspects of the program would be most likely to be classified as secondary prevention? A) Regularly scheduled wound dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing B) Teaching school children how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes C) Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked D) Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes
C) Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked
18. An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prognosis enhancement
C) Tertiary prevention
Etiology
Causes of disease, including biological agents, physical forces, chemical agents, one's genetic inheritance, and nutritional excesses or deficits.
The cell surface is surrounded by a cell coat (glycocalux.). Select the most important function of the cell coat.
Cell-to-cell recognition and adhesion.
A patient comes to the clinic complaining of severe pain in the left great toe and is diagnosed with gout. What medication does the nurse anticipate educating the patient about that stops cell mitosis in the treatment of gout?
Colchicine.
Select the main function of the nervous tissue.
Communication.
Risk factors
Conditions suspected of predisposing and contributing to the development of a disease.
3. A physician is providing care for a number of patients on a medical unit of a large, university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that cause disease. Which of the following patients most clearly demonstrates the consequences of molecules that cause disease? A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion of packed red blood cells B) A 91-year-old woman who has experienced an ischemic stroke resulting from familial hypercholesterolemia C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen therapy and chest physiotherapy D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive.
D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive.
13. A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which of the following statements best conveys an accurate epidemiological characterization of the disease? A) Low mortality; high morbidity; low prevalence; high incidence B) Low mortality; high morbidity; high incidence; low prevalence C) High mortality; low morbidity; high incidence; low prevalence D) High morbidity; low mortality; high prevalence, low incidence
D) High morbidity; low mortality; high prevalence, low incidence
19. The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse's task? A) Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences. B) Guidelines are synonymous with systematic research reviews. C) The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable. D) The guidelines will combine individual expertise with external systematic evidence.
D) The guidelines will combine individual expertise with external systematic evidence.
12. As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of A) what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park. B) the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park. C) the low rate of morbidity one can expect while traveling to Yosemite National Park. D) the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.
D) the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.
Evidence based practice
Decision making in health care based on scientific data advocating specific disease management protocols.
Congenital conditions
Defects that are present at birth, although they may not be evident until later in life or may never manifest.
Secondary prevention
Detects disease early when it is still asymptomatic and treatment measures can effect a cure or stop disease progression.
Tertiary prevention
Directed at clinical interventions that prevent further deterioration or reduce complications of a disease once it has been diagnosed.
Primary prevention
Directed at keeping disease from occurring by removing all risk factors.
Clinical disease
Disease manifested by signs and symptoms.
A patient has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the patient that this disease may be caused by disregulated apoptosis. Later that day, the patient asks the nurse what this means. The nurse should reply:
Dysregulated apoptosis has caused an excessive rate of programmed cell death along the neuro-pathways.
Which form of signal transduction resulting from ligand-receptor binding has the potential to produce effects in the entire body system?
Endocrine.
Which of the following statements regarding cell metabolism is most accurate?
Glycolysis also provides energy in situations when delivery of oxygen to the cells is delayed.
Chronic disease
Health condition running a continuous course or presenting with exacerbations and remissions.
Smooth muscle contractions are typically characterized as:
Involuntary.
Sequelae
Lesions or impairments that follow are caused by a disease.
The living part of the cell found both inside and outside of the nucleus is called protoplasm. This material is composed of proteins, carbohydrates, electrolytes, water, and what other substance?
Lipids.
Select the organelle that is responsible for the breakdown of excess and worn-out cell parts as well as foreign substances that are taken into the cell.
Lysosomes.
Apoptosis (programmed cell death) is regulated by:
Mitochondria.
What cellular organelle transforms organic compounds into energy that is easily accessible to the cell?
Mitochondria.
A couple is scheduled to obtain familial lineage studies. The nurse is aware that an analysis occur identifying maternally inherited:
Mitochondrial DNA.
In Tay-Sachs disease, an autosomal recessive disorder, hexosaminidase A, which is the lysosomal enzyme needed for degrading the GM2 ganglioside found in nerve cell membranes, is deficient. Although GM2 ganglioside accumulates in many tissues, where does it do the most harm?
Nervous system and retinas.
A school nurse is teaching a class on immunity. What is an accurate explanation about cellular defenses?
Neutrophils engulf invading organisms where lysosomes break them down.
What are the three main parts of a typical cell?
Nucleus, Cell membrane, and Cytoplasm.
While reviewing the basic information related to hemodialysis, the professor explains that water molecules move through adjacent phospholipid molecules in the cell membrane by:
Osmosis.
The nurse is performing an assessment with a client that presents with blisters on the skin and mucous membranes. What primary disorder of desmosomes does the nurse suspect the client may be suffering from?
Pemphigus.
During a discussion on cellular components and their function, a student asked the instructor the purpose of messenger RNA (mRNA). Of the following, which is the most accurate answer? -Assists cells in forming neoplastic progression by altering the response of chromatin in the nuclear matrix. -Performs an active role of protein synthesis, where mRNA molecules direct the assembly of proteins on ribosomes to the cytoplasm. -To transport amino acids to the site of protein synthesis. -Acts as an inner nuclear support membranes for a rigid network of protein filaments that binds DNA to the nucleus.
Performs an active role of protein synthesis, where mRNA molecules direct the assemble of proteins on ribosomes to the cytoplasm.
The student is studying membrane potentials. Which of the following membrane potentials is essentially a potassium equilibrium potential?
Resting membrane potential.
When describing the structures of the cell membrane, how does the pathophysiology instructor identify the various roles/functions?
Separates intracellular environment from extracellular environment, holds and binds receptors for hormones, and participates in the conduction of electrical currents in muscle cells.
A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the client's pathology?
Simple columnar epithelium.
A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the client's pathology?
Simple columnar epithelium.
While explaining cellular membrane potentials, the instructor states that during an action potential, the cell membrane becomes more permeable to which mineral/electrolyte?
Sodium.
Morbidity and mortality
Statistics useful in anticipating public health needs, planning educational programs, directing research, and allocating funds.
A client has an elevated troponin level. What conditions could this indicate? Select all that apply. -Pulmonary embolus -Strained flexor muscle -Myocardial infarction -Cerebral vascular accident -Peptic ulcer disease
Strained flexor muscle, and myocardial infarction.
The student is examining a tissue sample with a microscope. The student decides that it is squamous keratinized tissue. Which type of epithelial tissue is the student viewing?
Stratified epithelium.
The nurse is explaining the workings of selective serotonin reuptake inhibitors to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is:
Synaptic signaling.
A Jewish couple that is trying to conceive ask the nurse if they should receive genetic counseling. The nurse is aware that an autosomal recessive disorder that causes a deficiency in hexosamininidase A may be present. What disorder should the couple be tested for?
Tay-Sachs disease.
Diagnosis
The designation as to the nature or cause of a health problem.
Subclinical disease
The disease is not clinically apparent and is not destined to become clinically apparent.
Preclinical stage
The disease is not clinically evident but is destined to progress to clinical disease.
Validity
The extent to which a measurement tool measures what it is intended to measure.
Predictive value
The extent to which an observation or test result is able to predict the presence of a given disease or condition.
Reliability
The extent to which an observation, if repeated, gives the same result.
Sensitivity
The proportion of people with the disease showing positive for that disease on a given test or observation, called a true positive result.
Specificity
The proportion of people without the disease or negative on a given test or observation, called a true negative result.
Pathogenesis
The sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. (explains how the disease process evolves)
Signs and symptoms
The structural and functional changes that accompany a disease.
Pathophysiology
The study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease and their effects on total body function.
The number of mitochondria in a given cell type is largely determined by:
The type of activity the cell performs.
Which of these roles does adipose tissue play in the body?
Thermal insulation.
The homecare nurse is making a home visit to a 51 yo female client with a longstanding diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process is ultimately manifested as a failure of what normal process in muscle tissue?
Thick myosin and thin actin filaments sliding over each other.
How does facilitated diffusion enable molecules to cross cell membranes?
Transport proteins carry molecules to areas of lower concentration.
The majority of the cell's protoplasm is what?
Water.
Examples of multifactorial diseases?
cancer, heart disease, high blood pressure, and diabetes
Aspects of Disease?
etiology, pathogenesis, morphologic changes, clinical manifestation, diagnosis, and clinical course
Cross-Sectional Study
for classification of exposure and outcome. Research involves using different groups of people who differ in the variable of interest but share other characteristics
Cohort
is a group of people who were born at approximately the same time or share some characteristics of interest. People enrolled in this study (also called longitudinal study) are followed over a period of time to observe a specific health outcome.
Natural History
refers to the progression and projected outcome of the disease, without medical intervention Knowledge of this can be used to determine disease outcome, establish priorities for health care services, determine the effects of screening and early detection programs.