Chapter 3:Inflammation and Tissue Repair

The parents of a child diagnosed with rheumatic disease are shocked by the diagnosis and tell the nurse that they did not think children could acquire the disease. The best response would be:

"Children can be affected with almost all of the rheumatic diseases that occur in adults."

Which client likely faces the greatest risk of a gastrointestinal bleed?

A client who takes aspirin with each meal to control symptoms of osteoarthritis

The student nurse is removing sutures on client after abdominal surgery, and the wound begins to pull apart. The student asks the instructor, "Did I do something wrong?" The instructor reviews wound healing and replies:

"Maybe the wound edges were not close enough together to allow epithelialization of the wound to occur."

The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client makes which statement?

"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular.

Following an injury that resulted in a major wound, the client notes that on day 2, the wound looks a little different. The client also notes that if he just brushes the skin accidentally with a towel, it bleeds easily. The client asks why this happens. Which is the best response by the nurse?

"There is new granulation tissue forming that contains many newly developed, fragile capillary buds."

A client has experienced an acute inflammatory response with an elevation of white blood cells. The nurse is reviewing the client's most recent lab results to determine if the counts have returned to a normal range. Select the result that suggests the client is now within normal range.

4000 to 10,000 cells/μL

A nurse is researching the prevalence and risk factors of inflammatory bowel disease (IBD). Which ethnicity does the nurse discover has four to five times greater prevalence than other groups?

American Jewish

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered?

Amylase and lipase

A nurse is caring for a client admitted for a systemic infection. The client has leukocytosis. What other laboratory value does the nurse anticipate the health care provider to order?

C-reactive protein (CRP)

Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description?

Cobblestone

A client underwent an open cholecystectomy 2 days ago, and the incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the client's healing?

Collagen secretion by fibroblasts

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of:

Crohn disease

When assessing a client's incision, the nurse notes that the edges of the once approximated incision has begun to pull apart. The nurse documents that the client's incision has:

Dehisced

After a tornado, an adolescent was found dead near a "live" wire from a downed electrical pole. While trying to explain to the family what caused this death, which statement(s) by the nurse is appropriate? Select all that apply

Electrical injuries follow the path of least resistance, that is along tissues, fluids, and blood vessels. The electrical current can pass through organs and blood vessels. Electrical currents disrupt cardiac conduction and cause immediate death.

The nurse is reviewing assessment documentation of a client's wound and notes "purulent drainage." The nurse would interpret this as:

Exudate containing white blood cells, protein, and tissue debris

Which response by the nurse answers a client's question regarding the most common objective sign of systemic inflammation during the acute-phase response?

Fever

When caring for a client during the proliferative phase of wound healing, the nurse teaches the client that which of these processes is taking place?

Fibroblasts secrete collagen for wound healing.

A client asks the nurse why a scar developed after an injury. Which response by the nurse is most accurate?

Fibrous tissue

In clients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all clients with diarrhea is:

Fluid and electrolyte status

The most common forms of peptic ulcer are duodenal and gastric ulcers. What are the most common risk factors for peptic ulcer disease?

Helicobacter pylori (H. pylori)

A client with environmental allergies is experiencing respiratory inflammation. Which mediator causes vasodilation during the vascular stage of the inflammatory response?

Histamine

The nurse is caring for a client who has developed facial swelling related to a hypersensitivity reaction to a medication. Which of these substances does the nurse recognize is implicated in causing this type of reaction?

Histamine

An older adult client has had mobility and independence significantly impaired by the progression of rheumatoid arthritis (RA). What is the primary pathophysiologic process that has contributed to this client's decline in health?

Immunologically mediated joint inflammation

The nurse is evaluating the bloodwork results of a client with an infected leg ulcer. The white blood cell count is 18,000 cells/uL. The nurse interprets this as:

Leukocytosis

What laboratory markers are most commonly used to diagnose acute pancreatitis?

Lipase and amylase

What function does hyaluronic acid (a component of the extracellular matrix) perform in the body?

Lubricates joints and serves as a supportive structure in the extracellular space throughout the body.

During a lecture on inflammation, the physiology instructor discusses the major cellular components involved in the inflammation response. The instructor asks, "Which cells arrive early in great numbers?" Which student response is correct?

Neutrophils

The nurse is caring for a client with newly diagnosed systemic lupus erythematosus (SLE). Which over-the-counter medication does the nurse recognize is useful in treating inflammation, arthritis, and pleuritis?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A client is being seen in the dermatology clinic for a follow-up appointment for a second-degree full-thickness burn. What are characteristics of second-degree burns? Select all that apply.

Painful Blistered Mottled, pink red

The nurse caring for a postoperative client documents that the surgical incision is healing by

Primary intention

The nurse is assessing the wound of a postoperative client. The client has a 6-inch abdominal wound that is well approximated and closed with surgical suture. The wound does not display any redness or drainage. The nurse would document the healing process as:

Primary intention

The nurse would identify the presence of granulation tissue at a wound site by which characteristic?

Red, moist tissue

A client in the acute stage of inflammation will experience vasodilation of the arterioles and congestion in the capillary beds. The nurse would assess the client's skin for:

Redness

Which substance helps maintain a smooth surface in joint cartilage?

Synovial fluid

While explaining wound healing to an older adult client with a diabetic ulcer on the foot, which statement best explains the early process of how the body restores structural integrity?

The basement membrane must be restored before epithelial cells can form a covering over the wound.

Following hip replacement surgery, the client has had many weeks of physical therapy. Upon assessing the wound, it is still red and draining thick, green, odoriferous secretions. The client has limited range-of-motion and is constantly reporting pain. The physician explains that the hip device needs to be removed. Why is removal required?

The body considers the hip replacement device a foreign body and an infection has developed around the joint.

A client has presented to the emergency department after he twisted his ankle while playing soccer. Which assessment findings are cardinal signs that the client is experiencing inflammation? Select all that apply.

The client's ankle is visibly red The ankle appears to be swollen The ankle is warmer than the unaffected ankle The client is experiencing pain

Which clinical manifestation would lead the health care provider to diagnose the sunburn as severe?

There is blistering of the skin and associated fever and chills.

A client has sustained a full-thickness burn involving subcutaneous tissue, muscle, and bone. Which term will the nurse use when documenting this type of burn?

Third-degree burn

The nurse is caring for a client who has experienced hypovolemic shock secondary to penetrating multiple trauma. When caring for the client postoperatively, which of these factors does the nurse recognize places the client at risk for poor wound healing?

Tissue hypoxia

The nurse is caring for an obese client who has had abdominal surgery. The medical record states the wound has developed a dehiscence. Which finding does the nurse anticipate observing when changing the dressing?

Wound edges are 1.5 inches apart.

The nurse is assessing a client for acute inflammation of a wound. Which symptom does the nurse attribute to the acute inflammatory response?

edema

A client is experiencing the early stages of an inflammatory process and develops leukocytosis. The nurse recognizes this as a/an:

increase in circulating neutrophils.

The nurse is caring for a client with an accumulation of 2.5 cm of darkened tissue scar over the area of a 3-mm injury. How does the nurse correctly document this finding in the medical record?

keloid

While reviewing the phases of wound healing, the students note that the first cells to arrive after the injury are the:

neutrophils.

After many years of cigarette smoking, a client is admitted to have a "mass" removed from the lung. When explaining the surgery and recovery, the physician notes that the client is likely to have a good amount of fibrosis develop at the surgical area. After the physician leaves the room, the client asks the nurse what was meant by "fibrosis" in the lung. The nurse bases the response on the fact that tissue repair can:

result in replacement tissue in the form of connective (fibrous) tissue, which leads to scar formation or fibrosis of the lung.

While evaluating the diagnostic results for a client diagnosed with acute pancreatitis, which laboratory value(s) helps confirm that the pancreatitis was probably caused by gallstones? Select all that apply.

total bilirubin level of 10.4 mg/dl (177.88 µmol/l) aspartate aminotransferase (AST) level of 250 units/l (4.17 µkat/l)

The nurse is assessing a client with acute sinusitis. What is the primary cause of this condition?

viral infection transmitted via respiratory droplets