Pathophysiology exam 1
Which of the following statements would a nurse tell a patient to best describe apoptosis?
"Apoptosis is the natural removal of injured or worn out cells." Apoptosis refers to natural cell death via the body's programmed removal of inured or worn out cells. Hyperplasia is an increase in the number of cells, and hypertrophy is an increase in the size of cells. Necrosis is cell death of irreversibly damaged cell death or tissue which usually interferes with cell replacement and tissue regeneration.
A patient who was recently diagnosed with cancer and is worried that his cancer might spread asks the nurse how cancer spreads? Which of the following would be the nurse's best response?
"Cancer spreads through the lymph channels and the blood vessels." Explanation: Metastasis occurs through lymph channels and blood vessels.
A patient who has donated a kidney to his son asks what will happen to the patient's remaining kidney? Which of the following is the nurse's best response?
"Hypertrophy will occur as the kidney's workload increases." Explanation: Hypertrophy of the remaining kidney may occur as the result of normal physiologic workload. The remaining kidney enlarges to compensate for the loss. Atrophy is a decrease in cells and will not occur as a response to this change.
A patient with pulmonary hypertension has hypertrophy of the heart's right ventricle. Which of the following explanations is appropriate to tell the patient?
"The cells enlarge in your heart from the increased workload." 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.
A patient has been exercising his arms repeatedly. Which of the following explains the increase in the size of the arms?
"Your cells have hypertrophied in response to increased workload." Explanation: Hypertrophy represents an increase in cell size with an increase in the amount of functioning tissue mass. It is commonly seen in skeletal tissue muscle. Atrophy means a decrease in cell size. Oxygen does not cause the cells to increase nor do cells clump in response to exercise.
Which of the following clients are at high risk for developing dilated cardiomyopathy?
44 year old noncompliant female who forgets to take her hypertensive medications. Explanation: In hypertension, the increased workload required to pump blood against an elevated arterial pressure in the aorta results in a progressive increase in LV muscle mass and need for coronary blood flow. The pressure overload causes hypertrophied cells to have greater width and length. Paraplegia, cerebral palsy and Alzheimer's disease does not increase the workload of the cardiac muscle per se.
A nurse is caring for four clients. Select the client at greatest risk for high blood levels of lead.
A 2-year-old anemic child who lives in a turn-of-the-century home The client at the highest risk of having higher blood levels would be a young child who is likely to puts small toys in his or her mouth or ingests lead dust form soil. Factors that increase the risk of lead toxicity include preschool age, low socioeconomic status, and living in older housing built primarily before 1960. A client with a deficiency in calcium (hypocalcemia), iron, or zinc increases his or her risk of lead absorption. Behaviors that include smoking and working around wood have no apparent affect on the development of lead poisoning.
A nurse prepares an educational event for a group of single parents. The nurse is going to talk about drugs and the damage they can cause to the body. The nurse would likely include which of these drugs? (Select all that apply.)
Acetaminophen, an analgesic. Reslizumab, an immunosuppressant. Ethyl alcohol, a suppressant. Many drugs—alcohol, prescription drugs, over-the-counter drugs, and street drugs—are capable of directly or indirectly damaging tissues. Ethyl alcohol can harm the gastric mucosa, liver, developing fetus, and other organs. Antineoplastic (anticancer) and immunosuppressant drugs can directly injure cells. Other drugs produce metabolic end products that are toxic to cells. 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. Daily vitamin supplements that stay within the RDA do not usually cause toxicity or harm.
Which of the following is the process during which cells use energy to move ions against an electrical or chemical gradient?
Active transport Explanation: The process that moves ions against an electrical or chemical gradient is called active transport. This process of osmosis occurs when water moves through water channels in a semipermeable membrane along a concentration gradient, moving from an area of higher to one of lower concentration. Passive movement of particles or ions across the cell membrane is directly influenced by chemical or electrical gradients and does not require an expenditure of energy. Diffusion refers to the process by which molecules and other particles in a solution become widely dispersed and reach a uniform concentration because of energy created by their spontaneous kinetic movements.
According to Hans Selye, which of the following is the correct order of stages of the general adaptation syndrome?
Alarm, resistance, exhaustion Explanation: The general adaptation syndrome has three stages: alarm (fight or flight), resistance (fight), and exhaustion.
The nurse is caring for four clients. Select the client who is at greatest risk for decreased wound healing.
An 80-year-old diabetic client with a foot ulcer Explanation: Any client with an autoimmune disease (i.e., diabetes) is at greater risk for decreased wound healing because the healing process relies on the immune reaction. The client also has the added risk factor that age presents. While nutrition and age both play a role in wound healing, the remaining options have only one of the several factors that can affect wound healing.
Which of the following statements is true regarding drug therapy and its effects on the body?
Antineoplastic cells directly damage cells. Explanation: Antineoplastic drugs directly injure cells. Many drugs injure tissues and cells either through their direct mechanism of action, side effects, or adverse effects.
A client tells the nurse she takes vitamin E and vitamin C daily. She further explains that the purpose is to inhibit the reactions of reactive oxygen species (ROS) with biological structures and prevent the uncontrolled formation of ROS. The nurse identifies this process as a function of:
Antioxidants Explanation: Antioxidants are natural and synthetic molecules that inhibit the reactions of ROS with biological structures or that prevent the uncontrolled formation of ROS. Unpaired electrons are free radicals and ROS and do not prevent these reactions. Oxidative stress occurs when the generation of ROS exceeds the ability of the body to neutralize and eliminate ROS.
A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the nurse's advice?
Antioxidants inhibit the actions of reactive oxygen species. Explanation: Antioxidants inhibit the reactions of reactive oxygen species (ROS) with biological structures. Superoxide dismutase is an antioxidant itself, and ROS, not antioxidants, react non-specifically with molecules. Antioxidants do not prevent the occurrence of cell dysplasia.
The obstetric nurse explains to the client that when she stops breast feeding, her breast tissue will reduce in size. The nurse understands that this regression is due to which physiologic process?
Apoptosis Explanation: Apoptosis is thought to be responsible for several normal physiologic processes, including hormone-dependent involution of tissues (e.g., the regression of breast tissue after weaning from breastfeeding).
Which intervention should a nurse stress when teaching clients how to avoid exposure to lead in their environment? Select all that apply.
Avoid flaking paint. Lead can contaminate soil. Root vegetables can contain more lead than other vegetables. Explanation: Lead is a very toxic metal and small amounts can accumulate to reach toxic levels. The nurse should teach patients to avoid flaking paint, especially in older homes, as older paint contains lead. Lead can contaminate soil, and root vegetables tend to contain more lead.
A patent is diagnosed with an adenoma. The nursing student identifies this as being which of the following?
Benign tumor of glandular epithelial tissue Explanation: An adenoma is a benign tumor of glandular epithelial tissue. An osteoma is a benign tumor of bone tissue.
Marfan syndrome, which is a connective tissue disorder, affects several organ systems. The most life-threatening aspects of the disorder are caused by defects in which of the following systems?
Cardiovascular Explanation: Marfan syndrome affects several organ systems, including the cardiovascular, skeletal and ocular systems. The most life-threatening aspects of the disorder are the cardiovascular defects, which include mitral valve prolapse, progressive dilation of the aortic valve ring and weakness of the aorta and other arteries.
Which of the following happens when a cell is confronted with a decrease in work demands?
Cell becomes smaller. Explanation: As a cells' 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 patient with gastroesophageal reflux disease has metaplasia. Which of the following is the cause?
Cells are replaced in response to chronic irritation. Explanation: Metaplasia represents a reversible change in which one adult cell type is replaced by another adult cell type in response to chronic irritation and inflammation.
The student is reviewing the aging process. One group of theories of aging involves the shortening of telomeres until a critical minimal length is attained and then senescence ensues. These theories are known as which of the following?
Cellular theories Explanation: There are a number of cellular theories of senescence that are under investigation, including those that focus on telomere shortening.
Which of the following statement is not true concerning chromosomes?
Chromosomes do not retain integrity between cell divisions. Explanation: Chromosomes retain integrity between cell divisions. All of the other statements are true.
A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother's pregnancy history?
Chronic alcohol use Explanation: The infant's signs and symptoms are characteristic of fetal alcohol syndrome. Folic acid deficiency is associated with neural tube defects, such as anencephaly and spina bifida. Cocaine use is associated with some of the same signs and symptoms as alcohol use but does not produce the characteristic facial abnormalities of fetal alcohol syndrome. Herpes simplex infection, although it is associated with microcephaly, hydrocephalus, defects of the eye, and hearing problems, also does not produce characteristic facial abnormalities.
The nurse is caring for a patient brought to the emergency department by emergency medical personnel after choking on a peanut and collapsing. The emergency personnel were able to partially clear the obstruction, but the patient experience prolonged hypoxia. The nurse anticipates that the resulting cerebral infarction will lead to which of the following?
Coagulation necrosis Tissue infarction is caused by prolonged oxygen deprivation, and the resulting large group of dead cells coagulates in the damaged area. 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 patient is admitted with frostbite. Which of the following will the nurse tell the patient about the changes that have occurred due to cold exposure?
Cold increases blood viscosity and thrombosis. Explanation: Cold temperature exposure causes increased blood viscosity and can cause clots to form. Vasoconstriction is induced, and the flow of blood is slowed due to this. Cells do not hypertrophy in response to temperature change.
Abnormalities of body structure, function or metabolism that are present at birth are known as which of the following?
Congenital Explanation: Congenital defects, sometimes called birth defects, are abnormalities of body structure, function or metabolism that are present at birth. A teratoid is a chemical, physical or biologic agent that produces abnormalities during embryonic or fetal development. Neonatal refers to the period of time that is 28 days after birth. Premature is the state of an infant being born prior to completion of the 37th week of gestation.
The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client's sclerae are jaundiced. The nurse recalls that jaundice is a pigment that can accumulate in which part of the cell?
Cytoplasm Explanation: Pigments such as bilirubin and melanin can accumulate in the cytoplasm, resulting in the characteristic yellow skin tones associated with jaundice. Pigments do not tend to accumulate in the nucleus, Golgi apparatus, or rough ER.
A nurse is the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which of the following phenomena has contributed to his tissue damage?
Decreased blood flow has induced hypoxia. Explanation: Damage from exposure to cold results from hypoxia, ice crystal formation and vasoconstriction. Blood viscosity increases, not decreases, and vasoconstriction rather than vasodilation occurs.
Which of the following factors can increase the absorption of lead into a patient's system?
Decreased calcium levels in the blood A deficiency in calcium, iron, or zinc increases lead absorption.
A client's condition has resulted in a decrease in work demands of most cells in the body; the anticipated result would be:
Decreased size of organelles Explanation: Cell atrophy results in a decreased number and size of cell organelles. With cell atrophy, the cell has decreased oxygen consumption and growth of the mitochondria. The cell decreases in size. When confronted with a decrease in work demands or adverse environmental conditions, most cells are able to revert to a smaller size and a lower and more efficient level of functioning that is compatible with survival. This decrease in cell size is called atrophy. Cellular death process is not affected.
The nurse caring for a client with a large leg wound notes that the client's past medical history includes diabetes, chronic atrial fibrillation, asthma controlled by maintaninence medication, and neuropathy. Which one has the greatest potential to negatively impact the healing of the client's wound?
Diabetes Explanation: The client's diabetes has the greatest potential to negatively impact the client's wound healing as this places the client at risk for delayed wound healing and infection from hyperglycemia.
Select the option that most accurately describes the process resulting in specialized cells.
Differentiation Explanation: Cell differentiation is the process whereby a cell becomes more specialized in terms of structure and function. Cell proliferation refers to the process of increasing cell numbers by mitotic division. Stem cells are undifferentiated cells that have the capacity to generate multiple cell types. Cell death is called apoptosis. The cell cycle is an orderly sequence of events that occur as a cell duplicates its genetic contents and divides.
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 Disuse atrophy occurs when there is a reduction in skeletal muscle use (which occurs in a casted limb). Denervation atrophy is a form of atrophy that occurs in muscles of paralyzed limbs. With malnutrition and decreased blood flow, cells decrease their size and energy requirements.
A patient's lab report returns and a nurse is explaining to the patient the significance of the changes. The nurse states that the finding is implicated as a precursor of cancer. Which of the following finding was most likely on the lab report?
Dysplasia Explanation: 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.
A nurse practitioner is preparing to perform a client's Papanicolaou (Pap) smear and is answering the client's questions about the clinical rationale for the procedure. The nurse should describe what phenomenon?
Dysplasia of the cervical epithelium is associated with a high risk of cancer. Explanation: A Pap smear 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.
Which statement is true concerning chromosomes?
Each human somatic cell has 23 pairs of different chromosomes Explanation: Each human somatic cell has 23 pairs of different chromosomes, one pair derived from the individual's mother and the other from the father. One of the chromosome pairs consists of the sex chromosomes. Genes are arranged linearly along each chromosome. Each chromosome contains one continuous linear DNA helix.
A teratogenic environmental agent can cause birth defects when:
Exposed during early pregnancy Explanation: Teratogenic environmental agents cause birth defects when the fetus is exposed directly during fetal development. Recessive single-gene disorders are inherited from carriers or affected parents and are not affected by toxic agent exposures. Exposure to teratogenic agents at birth will not cause genetic defects in that infant. Disjunction during first or second meiosis is characteristic of aneuploidy disorders such as trisomy 21, Down syndrome, and is unrelated to maternal environment or in utero exposures.
Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:
Extend throughout the pregnancy Unlike other teratogenic exposures that cause abnormalities during a short period of time during fetal development (usually in the early weeks), fetal alcohol (FAS) damages the chromosomes of the developing fetus as long as alcohol continues to circulate through the fetal bloodstream. FAS is diagnosed by the presence of three findings that do not include liver abnormalities and are not life threatening. Facial features characteristic of FAS are most noticeable during childhood.
In a genetic disorder called xeroderma pigmentosum, an enzyme needed to repair sunlight-induced DNA damage is lacking. This autosomal recessive disorder is characterized by what?
Extreme photosensitivity and a greatly increased risk of skin cancer in skin that has been exposed to the sun
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?
Fish such as tuna and swordfish Explanation: The main source of methyl mercury exposure is from consumption of long-lived fish, such as tuna and swordfish. Although there is mercury in amalgam fillings, the amount of mercury vapor given off by the fillings is very small. Most thermometers today are made without mercury. The same holds true for most blood pressure machines. Lead in paint is a concern, not mercury.
The most critical time for teratogenic influence in embryonic development is which one of the following?
From day 15 to day 60 after conception Explanation: The embryo's development is most easily disturbed during the period when differentiation and development of the organs are taking place. This time interval, which is often referred to as the period of organogenesis, extends from day 15 to day 60 after conception.
After exposure to poison ivy, the client has hives on his trunk and extremities. In an effort to decrease his immune response the practitioner places him on which of the following medications?
Glucocorticoid Explanation: Glucocorticoids are know to suppress immune function, and pharmacologic doses of cortisol are used clinically to suppress the immune response. The other options do not decrease the immune response.
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 release endotoxins that cause cell injury and increased capillary permeability. 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 of the following assessments supports the finding of lead toxicity?
Hemoglobin 9 g/dL 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.
A 7 year old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis?
Hemoglobin 9.9 g/dL Explanation: Anemia is the cardinal sign of lead toxicity. Neither muscle pain, decreased deep tendon reflexes nor changes in WBC levels is associated with lead toxicity
Select the statement the best describes apoptosis.
Highly selective in eliminating injured or aged cells Explanation: Apoptosis is a highly selective process that eliminates injured and aged cells in a manner that maintains the integrity of the plasma membrane and does not initiate inflammation. All the other options describe the occurrences of necrosis.
A client with environmental allergies is experiencing respiratory inflammation. Which mediator causes vasodilation during the vascular stage of the inflammatory response?
Histamine Explanation: Histamine is a key mediator in the inflammatory system and one that induces vasodilation during the vascular stage. Adhesion molecules, memory T cells, and leukotrienes do not participate in the process of vasodilation during the vascular stage.
A patient asks why her breasts are enlarged during pregnancy. Which of the following is the best answer?
Hyperplasia due to estrogen stimulation Explanation: Physiologic hyperplasia results from estrogen stimulation during pregnancy, causing the breasts and uterus to enlarge.
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 Explanation: Cells adapt to changes in their environment and in their work demands by changing their size, number, and characteristics. An increase in work results in cells undergoing hypertrophy and increasing in size. Hyperplasia is an increase in the number of cells in an organ or tissue. A decrease in work demands or adverse environmental conditions results in cells atrophy, or reducing in size. Hypoplasia is underdevelopment or incomplete development of a tissue or an organ.
The 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 which of the following?
Hypertrophy Explanation: In pressure overload, as occurs with hypertension, the muscle cells hypertrophy to increase the amount of functioning tissue.
A patient is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which of the following aspects of this abnormality?
Hypoxia Lack of oxygen or hypoxia is a common cause of cell injury. Hypocapnea, alkalemia, and hypercapnea are not typical mechanisms of injury. The other common major mechanisms of cell injury are free radical formation, adenosine triphosphate depletion and disruption of intracellular calcium homeostasis.
The nurse is conducting a physical assessment of a homeless man during a night when the windchill factor is -10 degrees Farenheit. When assessing the man's fingers and toes for frostbite, the nurse looks for which of the following types of cellular injury?
Hypoxic Explanation: Exposure to cold increases blood viscosity and induces vasoconstriction by direct action on blood vessels and through reflex activity of the sympathetic nervous system. The resultant decrease in blood flow may lead to hypoxic tissue injury, depending on the degree and duration of cold exposure.
Two patterns of reversible cell injury can be seen: cellular swelling and fatty change. Cellular swelling is usually the result of which of the following?
Hypoxic cell injury Explanation: Cellular swelling occurs with impairment of the energy-dependent Na+/K+-ATPase membrane pump, usually as the result of hypoxic cell injury
A patient tells the nurse that he is receiving cancer treatment that involves strengthening the immune system. The nurse documents that the patient is receiving which of the following?
Immunotherapy Explanation: The nurse documents that the patient is receiving immunotherapy, defined as a cancr treatment modality designed to heighten the person's general immune responses in order to increase tumor destruction.
A client is experiencing the early stages of an inflammatory process and develops leukocytosis. The nurse recognizes this as an:
Increase in circulating neutrophils Explanation: Leukocytosis, or the increase in white blood cells, is a frequent sign of an inflammatory response, especially those caused by bacterial infection. Leukocytosis occurs due to an increase in circulating neutrophils and eosinophils. Leukocytosis does not occur because of increased cell production, and blood supply is typically increased as part of the inflammatory process.
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which of the following lab results would the provider expect to see?
Increased blood glucose Explanation: Cortisol, a glucocorticoid, maintains blood glucose levels (increases them) by antagonizing the effects of insulin. It also suppresses hematopoiesis, protein and collagen synthesis and immune responses (decreases white blood count).
A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?
Increased blood pressure and heart rate; increased antidiuretic hormone (ADH). Explanation: Increases in ADH, blood pressure and heart rate are all associated with the stress response. Testosterone and somatomedin C are decreased in prolonged stress exposure. Gastrointestinal motility is decreased, not increased, during stress.
A nurse is teaching a client about the effects of UV radiation. Exposure to UV radiation would place the client at greatest risk for:
Increased risk of cancer Explanation: 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.
Which of the following would help a nurse best describe a finding of hypertrophy on a lab report?
Increased size of the cell Hypertrophy is an increase in the size of the cell.
A client has developed dystrophic calcification as a result of macroscopic deposition of calcium salts. The tissue that would be most affected would be:
Injured tissue Explanation: Pathologic dystrophic calcification occurs in injured tissue. The components of the calcium deposits are derived from the bodies of dead or dying cells as well as from the circulation and interstitial fluid. It also occurs when the tissues have smaller amounts of iron, magnesium, and other minerals. Metastatic calcification occurs in normal tissue.
The radiologist is reviewing potential types of radiation therapy for a client. Select the type of radiation that directly breaks down chemical bonds in a cell.
Ionizing radiation Explanation: Ionizing radiation affects cells by causing ionization of molecules and atoms in the cell by directly hitting the target molecules of the cell and/or by producing free radicals that interact with critical cell components. Nonionizing radiation exerts it effects on the cell by causing a vibration and rotation of atoms and molecules. Sunlight is a form of ultraviolet radiation that induces skin damage by reactive oxygen species and by damage to the melanin-producing processes in the skin.
A patient who has undergone radiation therapy is expected to have some necrosis of cells. Necrosis is which of the following types of side effect?
Irreversible cell damage Explanation: 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.
A client has developed cell atrophy. The most likely cause would be:
Ischemia Ischemia, or decreased blood flow, results in cell atrophy as cells decrease their size and energy requirements as a means of survival. The general causes of atrophy can be grouped into five categories: (1) disuse, (2) denervation, (3) loss of endocrine stimulation, (4) inadequate nutrition, and (5) ischemia or decreased blood flow.
Which of the following statements is true concerning DNA structure and function?
It is very stable. Explanation: The DNA that contains genetic information is extremely stable. Because of its stable structure, the genetic information carried in DNA can survive the many stages of cell division and the day-to-day process of cell renewal and tissue growth. It also allows the information to survive the many processes of reduction division, the fertilization process, and the mitotic cell divisions involved in the formation of a new organism.
Which of the following statements is true concerning hyperplasia?
It's a response to stimulus Hyperplasia is an increase in the number of cells in an organ, not the size of cells, and is the response to a stimulus that is a controlled process that occurs in response to an appropriate stimulus.
Which of the following statements is true in relation to lead exposure?
Lead is absorbed through the gastrointestinal tract or the lungs. Lead is absorbed through the gastrointestinal tract and the lungs. It is not absorbed through the skin. Decreased calcium and iron increases the risk of lead poisoning.
The nurse evaluating the bloodwork results of a client with an infected leg ulcer. The white blood cell count is 18,000 cells/uL. The nures inteprets this as:
Leukocytosis Explanation: A white blood cell count of 18,000 cells/uL is indicative of an elevated white blood cell count or leukocytosis (normal range is 4000-10,000 cells/uL). This would be an expected finding in a client with an infected leg ulcer. An increase in lymphocityes is lymphacytosis and neutropenia is a decrease in nuetriphils. Lymphadenitis is an inflammation in the lymph nodes.
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?
Make dietary changes and limit UV exposure. Explanation: 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 patient who has just recently been diagnosed with cancer asks the nurse what tumor markers are. Which of the following would be the nurse's best response?
Markers are antigens expressed on the surface of tumor cells. Explanation: Tumor markers are antigens expressed on the surface of tumor cells or substances released from normal cells in response to the presence of a tumor.
The nurse is counseling a heavy smoker about the dangers of smoking. The nurse tells the smoker that the due to persistent irritation of the lungs from carcinogens, columnar cells may turn into squamous cells as a method of adaptation known as which of the following?
Metaplasia Metaplasia usually occurs in response to chronic irritation and inflammation and allows for substitution of cells that are better able to survive under circumstances in which a more fragile cell type might succumb. An example of metaplasia is the adaptive substitution of stratified squamous epithelial cells for the ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker.
A client with diabetes who is diagnosed with a gangrenous right heel ulcer presents with a wound that has no line of demarcation, is spreading rapidly, and has a foul odor. The health care worker recognizes these manifestations as:
Moist gangrene Explanation: In moist gangrene, there is no line of demarcation between the normal and diseased tissues, and the spread of tissue damage is rapid. Moist gangrene often results in a foul odor caused by bacterial action at the site. Dry gangrene has a clear demarcation and spreads slowly. Gas and internal gangrene do not apply to this client's symptoms.
Which of the following exemplifies physiologic hypertrophy?
Muscle mass increase with exercise Hypertrophy that occurs as the result of normal physiologic conditions is seen as muscle mass increases with exercise. Heart size increase in hypertension is an example of pathologic increase, as is lung size increase in emphysema and cell increase with hypoxia.
A biochemical event, such as nucleotide change, deletion, or insertion, that produces a new allele is called which of the following?
Mutation Explanation: A mutation is a biochemical event, such as nucleotide change, deletion, or insertion, that produces a new allele. Polymorphism refers to genes that have more than one normal allele at the same locus. Although gene expression usually follows a dominant or recessive pattern, it is possible for both alleles of a gene pair to be fully expressed in the heterozygote. This is codominance. When a person inherits a dominant mutant gene, but fails to express it, it is called reduced penetrance.
A school nurse is teaching a class on immunity. Which statement contains an accurate explanation about cellular defenses?
Neutrophils engulf invading organisms where lysosomes break them down. Explanation: Phagocytosis is when a cell, such as macrophages or neutrophils, engulfs an invading organism or damaged cells. Once inside the cell, the encapsulated particle is broken down by lysosomal enzymes.
A client has developed an abnormal buildup of fatty changes in the liver due to an intracellular collection of triglycerides. The client is most likely experiencing:
Normal cellular accumulation Explanation: Normal cell accumulation can result from an increase in normal body substances such as, lipids, proteins, carbohydrates, melanin, and bilirubin that exceeds its metabolism or removal. An example of this type of process is fatty changes in the liver due to intracellular accumulation of triglycerides. Accumulation of exogenous products results when environmental agents and pigments cannot be broken down by the cell. Endogenous product accumulation results when products cannot be broken down that result from inborn errors of metabolism. Intracellular accumulations represent the buildup of substances that cells cannot immediately use or eliminate.
An elderly client asks the nurse what causes the functional decline that occurs with the process of aging. The best response would be:
Oxidative stress Explanation: In addition to the many diseases and altered health conditions that have been associated with oxidative damage, oxidative stress has been associated with age-related functional declines that underlie the process of aging. The endothelial dysfunction that contributes to the development, progression, and prognosis of cardiovascular diseases is thought to be caused in part by oxidative stress. Hypoxia deprives the cell of oxygen and interrupts oxidative metabolism and the generation of ATP, but there is no currently known connection to aging. The increased calcium level may inappropriately activate a number of enzymes with potentially damaging effects.
What happens as a cell's workload declines? Select all that apply.
Oxygen consumption decreases. Protein synthesis decreases. Cell size decreases. Explanation: As the cell's workload declines, oxygen consumption decreases, protein synthesis decreases, and cell size decreases. Insulin levels do not increase, and energy expenditure would decrease.
Which of the following best describes the consumption of a foreign substance, such as bacteria, in a cell?
Phagocytosis Explanation: Phagocytosis refers to the consumption of a foreign substance.. Energy transformation takes place without oxygen is referred to as anaerobic metabolism. Meiosis a type of cell division that results in two daughter cells each with half the chromosome number of the parent cell. Hemolysis refers to the destruction of red blood cells which leads to the release of hemoglobin from within the red blood cells into the blood plasma.
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 Explanation: Vasodilation of the arterioles and congestion of the capillary beds result in an increased pooling of blood leading to redness. The site would also have increased painful sensation and be warmer to touch. It would not result in an increase in bacterial load.
A diabetic client has injured his foot while walking barefoot on the lawn. On admission, which of the following assessment findings would be considered a localized cardinal sign of acute inflammation?
Redness and edema at the injured site Explanation: Localized manifestations include redness, swelling, and heat. Fever and fatigue are systemic manifestations of acute inflammation. Low urine output is not a localized sign but could be a systemic manifestation if the client goes into septic shock.
Which of the following health problems may be identified by a TORCH screening test?
Rubella and herpes Explanation: The acronym TORCH stands for toxoplasmosis, other, rubella (i.e., German measles), cytomegalovirus, and herpes, which are the agents most frequently implicated in fetal anomalies. The TORCH screening test examines the infant's serum for the presence of antibodies to these agents.
Which of the following types of epithelium is found in the lining of blood vessels, lymph nodes, and alveoli of the lungs?
Simple squamous epithelium Explanation: Simple squamous epithelium is adapted for filtration, which works well on the blood vessels, lymph nodes, and alveoli of the lungs. Stratified squamous keratinized epithelium makes up the epidermis of the skin. A pseudostratified ciliated columnar epithelium with goblet cells forms the lining of most of the upper respiratory tract. Transitional epithelium is well adapted for the lining of organs that are constantly changing their volume, such as the urinary bladder.
A client with pneumonia is admitted with these vital signs: temperature 99.7ºF, pulse 80 beats/min, respirations 18/minute, and BP 120/80 mmHg. Which set of vital signs does the nurse anticipate when the client begins to shiver and requests another blanket several hours later?
T 100.9ºF, P 90/min, R 20/min, BP 126/80 mmHg Explanation: During the chill phase of fever, the client feels cold and may experience pale skin with goosebumps, but the temperature is rising. When the body reaches the new set point, shivering will stop, and flushing will begin.
A 42-year-old female client with breast cancer has a tumor that is minimal in size and extension, has minimal regional lymph nodes involved, and has no distant metastasis. Using the TNM system the tumor is staged as:
T1, N1, and M0 Explanation: This client has T1—minimal size and extension of the tumor; N1—minimal regional lymph node involvement; and M0—no distant metastasis.
Which of the following enzymes listed below are responsible for cancer cells ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process?
Telomerase. Explanation: Some cells have telomerase, an enzyme that 'rebuilds' telomeres and lessens or prevents shortening. Cancer cells have high levels of telomerase, which prevents senescence and contributes to the cellular immortality that characterizes cancer.
A patient is admitted with an electrical burn and a fractured arm. Which cause related to the burn likely is responsible for the fracture?
The client had violent muscle contractions during the electrical injury. Explanation: The most likely scenario is that the client had an injury with alternating current (AC) that is usually more dangerous than direct current as it causes violent muscle contractions that can result in fractures and dislocations.
A 68 year old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client's condition?
The client has possibly undergone damage as a result of calcification following cellular injury. Explanation: Dystrophic calcification is a result of deposition of calcium following cellular injury, such as that which commonly occurs in heart valves. Answers A, B and D all refer to phenomenon associated with metastatic calcification and the associated increases in serum calcium levels
Which of the following statements is true concerning gene expression?
The degree to which a gene is active is called gene expression. Explanation: The degree to which a gene or particular group of genes is active is called gene expression. A phenomenon termed "induction" is an important process by which gene expression is increased. Gene repression is a process by which a regulatory gene acts to reduce gene expression. Whenever product levels decrease, gene transcription is increased.
Which of the following should be included in the teaching plan of care for the parents of a child diagnosed with Tay-Sachs disease?
The disorder involves accumulation of abnormal lipids. Explanation: In Tay-Sachs disease, a genetic disorder, abnormal lipids accumulate in the brain and other tissues, causing motor and mental deterioration beginning at approximately 6 months of age, followed by death at 2 to 5 years of age.
A person's genotype can best be described as which of the following?
The genetic makeup of an individual Explanation: The genetic makeup of an individual is known as a genotype. Phenotype is the observable expression of a genotype in terms of morphologic, biochemical or molecular traits. If the trait is expressed in the heterozygote (one member of the gene pair codes for the trait), it is said to be dominant. If it is expressed only in the homozygote (both members of the gene pair code for the trait), it is recessive.
A patient's history and physical indicate that the patient is a carrier of sickle cell anemia. The nurse anticipates which of the following?
The patient can transmit the disorder but does not exhibit symptoms. Explanation: Patients that are carriers of a disorder are able to transmit the disorder but do not exhibit signs and symptoms of that disorder.
A 62 year old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the Emergency Department, blood gasses reveal a slightly acidic blood sample. The nurse caring for this patient is not surprise with this result based on which of the following pathophysiological rationales?
The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise. Explanation: Heart muscle is efficient in converting lactic acid to pyruvic acid and then using the pyruvic acid for fuel. Pyruvic acid is an important source of fuel for the heart during heavy exercise when the skeletal muscles are producing large amounts of lactic acid and releasing it into the bloodstream. Therefore, the blood sample would be acidic by nature. Catabolism will break down stored nutrients and body tissues to produce energy. ATP conversion into ADP and phosphorylation of ADP to ATP are both aerobic metabolism processes.
The number of mitochondria in a given cell type is largely determined by:
The type of activity the cell performs Explanation: The number of mitochondria in a given cell type is largely determined by the type of activity the cell performs and how much energy is needed to undertake the activity. The nutrition the cell receives, the gender of the organism, and the number of similar cells in the organism do not have any influence on the number of mitochondria present in any individual cell type.
Which of the following describes how atrophied cells survive?
Through decreased oxygen consumption Explanation: When confronted with a decrease in work or adverse conditions, cells can atrophy to a smaller size and use less oxygen to survive.
A patient has suffered an electrical injury to the hand. Which of the following will the nurse expect to find?
Tissue damage at the skin site where the current entered the body Explanation: With an electrical injury, the nurse would expect the most severe injury at the site where the current entered the body. The skin could be blackened, reddened, and several layers of the skin could be destroyed depending on the severity of the injury. There is still injury if the client has dry thick skin, and there is no correlation between indoor versus outdoor injury.
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 increases the risk of skin cancer. Ultraviolet radiation damages DNA.
Which of the following is an example of physiologic hyperplasia?
Uterine enlargement in pregnancy Explanation: Two common types of physiologic hyperplasia are hormonal and compensatory. Breast and uterine enlargements during pregnancy are examples of a physiologic hyperplasia. The other examples are nonphysiologic hyperplasia.
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 one kidney is removed, the remaining kidney enlarges to compensate for the loss. Explanation: Compensatory hypertrophy is the enlargement of a remaining organ or tissue after a portion has been surgically removed or rendered inactive. The body does not enlarge its major organs during times of malnutrition. Gene expression, not actin expression, stimulates the body to increase the muscle mass of the heart. Hypertrophy is not a progressive decrease in the size of anything.
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?
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. Explanation: Injury from freezing probably results from a combination of ice crystal formation and vasoconstriction. The decreased blood flow leads to capillary stasis and arteriolar and capillary thrombosis. Edema results from increased capillary permeability. Exposure to low-intensity heat (43°C to 46°C), such as occurs with partial-thickness burns and severe heat stroke, causes cell injury by inducing vascular injury. The process of warming tissue that has been frozen or partially frozen causes pain. If the pain is bad enough, then medication to control the pain is given. Health team members are always concerned about giving pain medication to someone who might be an addict. Asking if this is the first time this person has had an injury induced by the cold is appropriate when taking a health history. However, pointing out that "it is obvious you are a homeless person" is not an appropriate remark for the nurse to make. Also not appropriate is wondering when it will happen again.
The nurse in an infectious-disease clinic will primarily treat injuries to tissues and cells caused by:
biologic agents 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
